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Article

Disease investigations for equine infectious anemia in Canada


(2009–2012) — Retrospective evaluation and risk factor analysis
Katharina L. Lohmann, Carolyn R. James, Sara N. Higgins, Krista J. Howden, Tasha Epp

Abstract — This retrospective study describes the detection of equine infectious anemia (EIA) during Canadian
Food Inspection Agency (CFIA) disease investigations in Canada, examines aspects of importance for disease
control, and evaluates potential animal-level risk factors for EIA in high-risk horses. Based on review of all
EIA-positive samples and all samples collected during disease investigations (N = 4553) over a 4-year period (2009
to 2012), 409 EIA cases were detected. Horse owners with EIA cases owned between 1 and 60 affected animals,
and 49 horses seroconverted during a disease investigation period. Twenty-nine percent of cases (n = 68) for which
this information was available had, or possibly had, clinical signs of EIA. Using a mixed effects logistic regression
model, horses in older age groups were at greater odds of having a positive EIA status. The study emphasizes the
importance of disease investigation activities when EIA is detected and identifies age as an animal-level risk factor
in high-risk horses.

Résumé — Enquêtes médicales pour l’anémie infectieuse équine au Canada (2009-2012)  –  Évaluation
rétrospective et analyse des facteurs de risques. Cette étude rétrospective décrit la détection de l’anémie infectieuse
équine (EIA) durant les enquêtes médicales de l’Agence canadienne d’inspection des aliments (CFIA) au Canada,
examine les aspects importants pour la maitrise de la maladie, et évalue les facteurs de risque potentiels au niveau
des animaux pour l’EIA chez les chevaux à risque élevé. Sur la base d’une revue de tous les échantillons positifs
pour l’EIA et tous les échantillons prélevés durant les enquêtes (N = 4553) pendant une période de 4 ans
(2009-2012), 409 cas d’EIA furent détectés. Les propriétaires de chevaux avec EIA possédaient entre
1 et 60 animaux affectés, et 49 chevaux ont séro-converti durant une période d’enquête. Vingt-neuf pourcents des
cas (n = 68) pour lesquels l’information était disponible avaient, ou avaient possiblement eu, des signes cliniques
d’EIA. Utilisant un modèle de régression logistique à effets mixtes, les chevaux des groupes d’animaux plus âgés
étaient à plus grand risque d’avoir un statut positif pour l’EIA. Cette étude fait ressortir l’importance des activités
d’enquêtes médicales lorsque l’EIA est détectée et identifie l’âge comme étant un facteur de risque au niveau de
l’animal chez les chevaux à risque élevé.
(Traduit par Dr Serge Messier)
Can Vet J 2019;60:1199–1206

Introduction EIA virus, and in the absence of licensed vaccines or effective

E quine infectious anemia (EIA) is a reportable disease in


Canada and a national disease control program is admin-
istered by the Canadian Food Inspection Agency (CFIA) under
treatments (3), disease control is accomplished by removal of
infected horses from the population through euthanasia or
life-long quarantine. Blood samples for owner-requested vol-
the Health of Animals Act and Regulations (1,2). Infected horses untary surveillance testing for EIA are collected by accredited
(subsequently referred to as all equines) remain carriers of the veterinarians and tested at private or provincial laboratories

Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus
Drive, Saskatoon, Saskatchewan S7N 5B4 (Lohmann, Epp, Higgins); Terrestrial Animal Health Epidemiology and Surveillance
Section, Canadian Food Inspection Agency, 8403 Coronet Road NW, Edmonton, Alberta T6E 4N7 (Howden); Canadian Food
Inspection Agency, 59 Camelot Drive, Ottawa, Ontario K1A 0Y9 (James).
Address all correspondence to Dr. Katharina L. Lohmann; e-mail: k.lohmann@usask.ca
Dr. Higgins’ current address is APHA, Melcombe Court, 1 Cumberland Drive, Weymouth, DT4 9TT, United Kingdom.
Dr. Howden’s current address is One Health Scientific Solutions, 150 Chippewa Road, Unit 258, Sherwood Park, Alberta T8H 0K4.
Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA
office (hbroughton@cvma-acmv.org) for additional copies or permission to use this material elsewhere.

CVJ / VOL 60 / NOVEMBER 2019 1199


CFIA-approved laboratory CFIA National Reference Laboratory

cELISA cELISA AGID EIA pos

EIA neg EIA neg EIA neg


A R T I C LE

Accredited veterinary CFIA veterinary inspectors


practitioners

Figure 1.  Overview of the protocol for equine infectious anemia (EIA) testing in
Canada. Solid arrows represent a non-negative (cELISA) or positive (AGID) result,
and dashed arrows represent a negative test result. For the few samples that have
non-definitive AGID results, further testing, and possibly sampling, is performed as
per established protocol. cELISA — competitive enzyme-linked immunosorbent assay;
AGID — agar-gel immunodiffusion; CFIA — Canadian Food Inspection Agency; EIA
neg — negative for EIA; EIA pos — positive for EIA (EIA case).

approved for EIA screening by the CFIA. Samples with non- have significantly higher viral loads (8). The policy also accounts
negative test results during this screening process (laboratory for the fact that although sensitive assays detect antibodies
referrals, Figure 1), and blood samples collected by CFIA against the EIA virus as early as 14 to 28 d after infection (3,9),
inspectors during disease investigations and before export of a small proportion of infected horses may, for various reasons,
horses to countries other than the US and Mexico, are tested at take longer to seroconvert (3,10). At a minimum, in-contact
the CFIA National Reference Laboratory to confirm a horse’s horses are therefore sampled 45 d after the last known exposure
EIA status. Less intense owner-requested surveillance for EIA to an EIA case to allow for detectable levels of antibody to be
in the western provinces was associated with an increase in the present. All horses on the index premises are tested until they
detection of EIA cases (2). receive a negative test result.
Complementary to voluntary surveillance efforts, the current One aspect in the assessment of risk for EIA virus transmis-
EIA control program in Canada mandates disease investigation sion concerns housing distance between horses. Transmission of
activities when an outbreak of EIA is detected. Based on OIE EIA virus by tabanids is purely mechanical (11) and requires that
definitions, an outbreak of EIA is the occurrence of 1 or more infected blood is transmitted to a second susceptible host within
confirmed positive cases in an epidemiological unit. An epi- hours (3,12), meaning it only takes place when a blood meal
demiological unit comprises 1 or more horses that are located is interrupted and then completed on a second host. Although
on a premises where the opportunity for disease transmission tabanids can travel long distances in general, they are unlikely
exists via the exchange of blood or bodily fluids. This may occur to change hosts when these horses are more than 50 m apart
through various events including the activity of large biting flies (13–15), and disease investigation testing includes horses that
(primarily tabanids), the use of contaminated medical or surgi- reside on a premises within 200 m of the index case. Physical
cal equipment, biting among horses, breeding, pregnancy, and distance between horses may be less relevant in the context of
nursing (3–5). Disease investigation activities undertaken by the iatrogenic transmission.
CFIA include “sampling, performing epidemiological investiga- In addition to distance, several previous studies have
tions, imposing movement restrictions, monitoring [and] order- addressed environmental and individual risk factors for natural
ing destruction” (6). Disease investigation testing pertains to all transmission of EIA virus. In 1 study (16), horse flies were most
horses that have been “in contact with the positive animal within active on hot days with bright sunshine and little or no wind,
30 d of the sampling date” (7). This may include horses on the while another study reported that tabanid activity was affected
same premises as the infected horse (index premises), horses on by barometric pressure, temperature, relative humidity, time
a different premises in close proximity to the index premises of day, and cloud cover (17). Young horses, especially young
(i.e., fence line contact), and horses that had contact with the foals, were at reduced risk of infection (18), which is possibly
infected horse at some point during the previous 30 d but are attributable to a more exaggerated defensive response to tabanid
no longer on the same premises (e.g., exposure during an event, feeding. Horses residing in flooded areas were at higher risk of
hospitalization, temporary housing). The policy on the timing being seropositive in Brazil (19). Interestingly, several studies
of testing in-contact horses takes into account the magnitude of showed that tabanids are less attracted to light-colored than
risk for virus transmission, which is thought to increase during dark-colored animals, and also less attracted to certain striped
fly-biting season and with the presence of clinical signs in the and spotted patterns than to homogenous colors (20,21). This
positive horse or its on-premises contacts as these horses likely behavior is attributable to differences in polarized light reflection

1200 CVJ / VOL 60 / NOVEMBER 2019


based on coat color; however, to our knowledge, the relevance N = 5271 EIA tests representing
of these findings has not been evaluated in the context of EIA 4553 samples*
671 samples excluded
transmission. (quality control, feral horses, etc.)
The study herein was undertaken in conjunction with our N = 3882 samples representing
previous investigation of owner-requested surveillance for EIA 2746 horses
Information from 1136 repeated
(2) and was centered on disease investigation activities within samplings condensed to a single
entry per horse
the current Canadian EIA control program. The first objec- N = 2746 horses

A R T I C LE
tive was to describe the extent of EIA detection during disease
investigations over a 4-year period, and to examine potential
issues of importance for disease control such as the extent of N = 2337 horses N = 409 EIA cases
seroconversion during disease investigations and the frequency EIA negative

of clinical signs in affected horses. A second objective was to


Figure 2.  Flow diagram showing the process of moving from
evaluate potential animal-level risk factors for EIA in this sub- sample-level information to horse-level information for the
group of high-risk animals. purposes of risk factor analysis. *Some samples (n = 718) were
tested by both cELISA and AGID and only the AGID result was
Materials and methods retained.

The study covered the period from January 1, 2009 to


December 31, 2012 and the sample population comprised all
EIA cases, and all horses tested as part of an EIA disease inves- origin: “East” included Ontario (ON), Quebec (QC), and the
tigation. Cases included those discovered based on sampling by Atlantic provinces (Nova Scotia, New Brunswick, Prince Edward
a private veterinarian accredited by the CFIA for this function Island, Newfoundland and Labrador) and “West” included the
(3) and those detected during a disease investigation. Yukon territory (YT), British Columbia (BC), Alberta (AB),
In accordance with the agency’s confidentiality rules, the Saskatchewan (SK), and Manitoba (MB). Sex was recorded as
CFIA provided information on submissions for EIA testing “male” or “female.” Breed type was categorized as “riding type”
to the CFIA National Reference Laboratory on a sample level. (Thoroughbred, Quarter Horse, Appaloosa, Paint, Arabian,
The database was limited to samples from disease investigations Morgan, Fjord, and a variety of other riding horses, includ-
and those submitted as laboratory referrals, i.e., referral for ing crosses in which at least 2 breeds were identified and each
additional testing after a non-negative competitive enzyme- individually fit into the riding type category), “draft” (Belgian,
linked immunosorbent assay (cELISA) result was obtained at an Clydesdale, and Percheron), “pony” (Pony, Miniature, Shetland,
approved private laboratory. Aside from the reason for testing, and Welsh), “crossbred” [horses identified as crossbreds, crosses
available information included the sample origin (province and in which only 1 breed was identified (e.g., Quarter Horse cross),
postal code), name and description of the tested horse, presence and crosses in which the identified breeds individually belonged
or absence of clinical signs, dates of sample submission and to different categories (e.g., Quarter Horse-Percheron cross)],
testing, applied tests [cELISA and/or agar-gel immunodiffusion and “other” (donkeys and mules). Coat color was categorized
(AGID)] and their results, and anonymized, coded informa- as “dark” (black, brown, bay, red bay), “light” (white, gray,
tion about the animal owner. For each sample, test results were palomino, cream, perlino, dunalino), and “other” (sorrel and
reviewed and categorized as “positive” or “negative.” If AGID any other identified color). Additional color descriptors were
testing was performed, the AGID result was considered the final considered for defining the light category; qualifiers of “dark”
result, and only samples positive by AGID were considered EIA (e.g., dark gray) and “dappled” (e.g., dappled palomino) were
positive; results reported as “AGID atypical” were considered interpreted as a darkening of the basic coat color, and those
negative. horses’ coat color was categorized as “other.” The color of any
Sample data were then reviewed to attribute test results to donkey described as “gray” was also categorized as “other.” Age
individual horses and identify repeated testing of individuals categorized as 0 to 5 y, 6 to 10 y, 11 to 15 y, 16 to 20 y or
over time. Due to the lack of a unique national identification $ 21 y was based on the age at the last recorded submission. If
system for horses, sample-level records were sorted by owner, the birth year rather than a numerical age was provided, the age
and available animal identifiers (breed, sex, name, age, descrip- at submission was calculated as the difference between the birth
tion, tattoo, tag) were reviewed to identify horses tested on more year and the year of submission. Equine infectious anemia status
than 1 occasion, with final verification provided by the CFIA. was categorized as “positive” (EIA case) or “negative” according
For horses tested more than once, seroconversion was defined to the last reported test result (if horses were tested more than
as a change in EIA test result from negative to positive during once). For all variables, a defined category was assigned if incon-
the time frame of the study. gruent information for the same horse over time individually
As the quality of information (e.g., description) varied fit into the same category (e.g., color was categorized as “dark”
between repeated records for some horses, a composite record for when subsequent records reported color as “black” or “brown”).
each horse was created for the purposes of risk factor analysis, Missing information, information entered as “unknown” and
retaining the available information for reason for test, region of incongruent information for the same horse over time that
origin, sex, breed type, coat color, age, and EIA status. Region could not be consistently assigned to 1 category was recorded as
was recorded as “East” or “West” according to the province of “unknown” and excluded from the risk factor analysis.

CVJ / VOL 60 / NOVEMBER 2019 1201


Table 1.  Cases of equine infectious anemia (EIA) by province (2009–2012). Cases identified as
laboratory referrals were previously described (2). During the time frame of the study, EIA was not
detected in Manitoba, Ontario, and the Atlantic provinces.
Number of positives (included number of laboratory referrals)
Province/territory
or region 2009 2010 2011 2012 Cumulative
Yukon territory 23 (n = 1) 11 (n = 11) 0 14 (n = 12) 48 (n = 24)
British Columbia 14 (n = 5) 3 (n = 1) 58 (n = 1) 8 (n = 2) 83 (n = 9)
A R T I C LE

Alberta 40 (n = 4) 5 (n = 2) 5 (n = 3) 26 (n = 6) 76 (n = 15)
Saskatchewan 4 (n = 1) 0 103 (n = 10) 83 (n = 11) 190 (n = 22)
Quebec 0 2 (n = 2) 10 (n = 0) 0 12 (n = 2)
Easta 0 2 (n = 2) 10 (n = 0) 0 12 (n = 2)
Westb 81 (n = 11) 19 (n = 14) 166 (n = 14) 131 (n = 31) 397 (n = 70)
Canada 81 (n = 11) 21 (n = 16) 176 (n = 14) 131 (n = 31) 409 (n = 72)
a Ontario,Quebec, Atlantic provinces (Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland and Labrador).
b Yukon territory, British Columbia, Alberta, Saskatchewan, Manitoba.

To test the association between potential risk factors (sex, age, Figure 2). Samples for 72 EIA cases (17.6%) were laboratory
breed, coat color, region) and outcome, univariable statistical referrals, i.e., they were originally taken by accredited veterinar-
analyses were completed using the STATA statistical pack- ians based on owner requests, and these have been previously
age (STATA 13, Software; StataCorp, College Station, Texas, described (2). The remaining 337 EIA cases were identified
USA). The association between each potential risk factor and during disease investigations. The overall ratio of EIA cases
EIA status was examined by using mixed effects logistic regres- discovered during disease investigations to those discovered
sion (STATA command melogit) accounting for clustering of by owner-requested surveillance testing, therefore, was 4.7:1.
horses by owner. An odds ratio (OR) with a 95% CI was used Table 1 and Figure 3 show the distribution of EIA cases across
to determine the association of each risk factor with EIA status, provinces, regions, and years of the study. Most cases of EIA
and P , 0.05 was considered significant. Only variables with a were detected in the western provinces.
P , 0.20 were assessed for inclusion in a multivariable model, A total of 288 horse owners were involved in disease investi-
with assessment of confounding using a 20% change in the gations. One hundred and eighty-six owners owned only horses
coefficient of interest and assessment of interaction of only that tested EIA negative, 57 owners owned a single EIA positive
biologically relevant relationships. The relationship between age horse, and 45 owners owned between 2 and 60 EIA positive
categories and outcome was visualized by graphing the predicted horses. The owner of the 3 affected donkeys and the owner of
probabilities and the 95% confidence intervals. An intraclass 1 of the mules also owned affected horses, while the second
correlation coefficient (ICC) was calculated based on the latent affected mule was the owner’s only affected animal.
variable approach to estimate the correlation in EIA status Based on submission dates, 49 horses seroconverted during a
among horses from the same owner. Assumptions of mixed disease investigation period; i.e., their EIA status changed from
effects models were examined by assessing residuals at the horse negative to positive during a time period considered to represent
and owner levels. Using commercial geographical information 1 disease investigation. One additional horse seroconverted dur-
system software (ArcGIS version 10.2.1; Environmental Systems ing the time frame of the study; however, dates of testing were
Research Institute, Redlands, California, USA), EIA cases were approximately 20 mo apart, suggesting the horse was involved in
mapped to the centroid of the owner’s postal code region identi- more than 1 disease investigation. Information on the presence
fied by a full 6-digit postal code, or the first 5 digits of a postal or absence of clinical signs was available for 233 EIA cases, all
code for a small number of observations (n = 3). of which were horses. Clinical signs were described as “present”
for 22 horses (9.4%), “possible” for 46 (19.7%), “absent” for
Results 87 (37.3%), and “unknown” for 78 horses (33.5%). Details
The database comprised information from 5271 EIA tests on concerning the nature of clinical signs were not available.
4553 samples; 718 samples were tested by both cELISA and Using a mixed effects logistic regression model, which
AGID and only the final AGID result was retained. Information accounted for clustering of horses by owner, the only animal-
from 671 samples was excluded from the study as samples were level factor significantly associated with a positive EIA status was
submitted for the purpose of quality control (n = 34), originated age (Table 2 and Figure 4). Model fit was acceptable based on
from feral horses (n = 3), because the identity of the tested assessment of residuals. Horses in the 3 oldest age groups had a
horses could not be verified (n = 233) or because laboratory significantly increased risk of an EIA positive status compared
referral samples ultimately tested negative and were not associ- with young horses (0 to 5 y). The intraclass correlation coef-
ated with a disease investigation (n = 401). Once repeated test- ficient (ICC) for this model was 0.60 (95% CI: 0.49, 0.71),
ing of some horses over time was accounted for, the remaining and the variance at the owner level was 5.0 (95% CI: 3.2, 8.0).
3882 samples represented the study population of 2746 animals;
409 that were categorized as EIA cases based on their last avail- Discussion
able test (404 horses, 3 donkeys, 2 mules) and 2337 that were Following our previous description of the incidence of EIA detec-
categorized as EIA negative (2322 horses, 12 donkeys, 3 mules, tion based on owner-requested testing alone, the first objective

1202 CVJ / VOL 60 / NOVEMBER 2019


A R T I C LE
Figure 3.  Location of cases of equine infectious anemia (EIA) identified during disease investigations from 2009 to 2012 (n = 409).
The symbols indicate the postal codes at which at least 1 EIA case was located. Most EIA positives (n = 397) were located in western
provinces (YT, BC, AB, SK) while 12 EIA positives were located in the East (QC). Also see Table 1.

of the current study was to describe the extent of EIA detection One limitation of the current EIA control program in Canada
during disease investigations and to examine issues of importance is that disease investigation testing is limited to those animals “in
for disease control such as seroconversion of in-contact animals contact with the positive animal within 30 days of the sampling
and the frequency of clinical signs in EIA positive horses at the date” (7); i.e., the extent of CFIA-requested testing is dictated
time of testing. In addition to the 72 EIA cases detected through by the date disease is detected in an index case. As subclinical
voluntary owner-requested testing at the accredited veterinary carriers of the virus are common (3) and clinical signs of a first
practitioner level, disease investigations identified 337 EIA cases infection may go undetected (22), the date of disease detection
(out of 2674 tested horses), indicating that most EIA cases in does not reflect the infection date in most cases. The current
Canada during the 4 years of the study were identified through 30-day disease response approach is therefore limited in its
disease investigation testing. The fact that individual owners capacity to identify all at-risk contacts, and ultimately affects
owned from 1 to 60 EIA positive animals suggested a wide range the ability to determine when a horse may have become infected
of degree of disease spread from individual animals, assuming or when it may have put others at risk. Even for horses that are
that horses belonging to 1 owner resided on the same prem- tested repeatedly for EIA throughout their lifetime, estimating
ises. One limitation of our study is that we cannot verify this the time point of infection is very difficult as, currently, there
assumption, or exclude the possibility that relationships beyond is no mandatory unique identification of horses in Canada, and
ownership status existed between EIA cases. For instance, the sample and animal level data are not collected in a consistent
same premises may have housed horses belonging to multiple manner when voluntary EIA testing leads to a negative result. In
owners, but this could not be determined from the available the context of our study, a time point of infection could only be
data. Nonetheless, in the context of disease control, it appears estimated for those horses that seroconverted during an ongoing
reasonable to emphasize the importance of testing potentially disease investigation or, in 1 case, within a 20-month period
exposed animals whenever a case of EIA is detected. between subsequent investigations.

CVJ / VOL 60 / NOVEMBER 2019 1203


Table 2.  Univariable analysis of potential risk factors associated with a positive equine infectious anemia (EIA) status of horses in Canada.
Animal-level risk factors were evaluated in a subset of high-risk horses (n = 2746) using mixed effects logistic regression with a random
intercept to account for clustering of horses per owner. Missing and inconclusive data were excluded from the analysis. P-values for the
overall analysis of each factor are indicated in bold.
Factor
N = horses Number of horses Number of EIA cases P-value
(farms) Categories (% of total) (proportion positive) OR (95% CI) (Category P-value)
Sex Male 1428 (54.7) 201 (14.1) ref a 0.91
A R T I C LE

N = 2611 Female 1183 (45.3) 171 (14.5) 1.01 (0.76, 1.35)


(279)
Age 0–5 y 821 (40.8) 123 (15) ref 0.0002
N = 2011 6–10 y 763 (37.9) 127 (16.6) 1.2 (0.83, 1.73) (0.34)
(256) 11–15 y 265 (13.2) 67 (25.3) 2.6 (1.58, 4.34) (, 0.001)
16–20 y 120 (6) 28 (23.3) 2.2 (1.09, 4.48) (0.03)
$ 21y 42 (2.1) 12 (28.6) 4.4 (1.65, 11.61) (0.003)
Coat colorb Dark 879 (46.3) 131 (14.9) ref 0.58
N = 1897 Light 148 (7.8) 20 (13.5) 0.69 (0.34, 1.4)
(232) Other 870 (45.9) 143 (16.4) 0.93 (0.65, 1.32)
Breed typeb Riding 937 (59.6) 154 (16.4) ref 0.38
N = 1573 Draft 54 (3.4) 5 (9.3) 0.29 (0.09, 0.97)
(229) Pony 182 (11.6) 42 (23.1) 0.92 (0.44, 1.93)
Crossbred 380 (24.1) 40 (10.5) 0.93 (0.44, 1.99)
Other 20 (1.3) 5 (25) 1.37 (0.27, 7.03)
Regionb East 143 (5.2) 12 (8.4) ref 0.35
N = 2746 West 2603 (94.8) 397 (15.25) 2.07 (0.45, 9.55)
(288)
a ref
— reference category.
b Categories
were defined as described in the materials and methods.

Forty-nine horses (12% of all EIA cases) seroconverted dur-


Marginal predicted probabilities (mean)

ing a disease investigation period, and assessment of testing 0.4 C

dates in light of the fact that seroconversion typically occurs 0.35


within 45 d of infection (21) suggested transmission may have
0.3
C BC
occurred shortly before the disease investigation began, or may
0.25
have continued after the initial case had been detected (data not
shown). Investigation of modes of transmission was beyond the 0.2 AB
A
scope of this study and, to our knowledge, modes other than 0.15
natural vector transmission were not confirmed for any of the
0.1
EIA outbreaks included in the study. When considering testing
0–5 6–10 11–15 16–20 211
dates, it was interesting to note that seroconversion in some
Age category (years)
cases occurred during the late fall and winter months when
tabanid activity is expected to be low or absent. Potential expla- Figure 4.  Age as a significant risk factor for EIA (P = 0.0002)
nations include longer than expected seroconversion periods or based on logistic regression analysis using a mixed effects model
non-tabanid modes of virus transmission. Evidence of ongo- and accounting for clustering of horses by owner. The predicted
probabilities of EIA cases within the various age categories
ing seroconversion during disease investigations in this study are shown. Categories with different superscript letters differ
supports the current approach of testing until all on-premises significantly from each other. Data are based on 2011 horses of
contact horses test negative at least 45 d after the last potential high risk, for which the age at last testing could be identified.
exposure to a known EIA case.
The existence of a subclinical carrier status makes EIA a diffi-
cult disease to control without routine testing. Of 233 EIA cases edema, and weight loss, with anemia and thrombocytopenia
that had this information available, fewer than 10% reportedly commonly detected on hematological tests (22).
had clinical signs at the time of testing, although clinical signs The second objective of this study was to evaluate potential
may have been present for an additional 19.7% of horses in animal-level risk factors for EIA. The subset of horses used for
which clinical signs were described as “possible.” While report- this analysis represented those at high risk for EIA, and this
ing on clinical signs may be inconsistent, this suggests a large fact has to be taken into account when interpreting our data
proportion of EIA cases in this study were subclinical carriers as the epidemiology of EIA, once the disease is introduced into
or, if clinical signs were present, they were not recognized at the a group, may be quite different compared to its epidemiology
time of testing or not attributed to EIA. Clinical signs associated in the overall population. The previously reported increased
with EIA include fever (acute or recurring), lethargy, pallor, risk for an EIA positive status in the western provinces, when

1204 CVJ / VOL 60 / NOVEMBER 2019


o­ wner-requested testing was evaluated (3), disappeared once The potential effect of light coat color was investigated in
clustering of horses by owner was taken into account in the our study, but we were not able to assess the effect of specific
mixed effects model. In other words, while more outbreaks color patterns as the descriptive information was not detailed
occurred in the West during the time frame of the study, the enough in most cases. Our categorization of coat colors followed
average number of EIA cases per owner did not differ signifi- stringent criteria to try to separate out the lightest and darkest
cantly between regions. If one assumes that horses belonging colored horses in an attempt to mimic experimental studies;
to the same owner reside together in most cases, this finding, however, coat color was not identified as a risk factor for EIA.

A R T I C LE
as well as the high ICC, suggests that proximity to an EIA While this may be attributable to some of the study’s general
case itself heightens the risk of EIA, which makes sense when limitations, it is also possible that tabanid species in Canada
natural transmission of the EIA virus is considered. Conversely, do not exhibit the same host-seeking behaviors as those previ-
the data could also be interpreted as consistent with individual ously studied. Tabanids may not have been the most important
owners’ higher-risk management practices, or lower farm-level contributor to disease risk during the time frame of our study,
biosecurity measures, being associated with a higher risk for or influences such as fly control methods were not equally dis-
EIA. Information about the transmission patterns in individual tributed across groups.
disease outbreaks would be required to conclusively interpret This study has several limitations, which are mostly attrib-
our data, but these were not investigated as part of this study. utable to inherent difficulties when retrospectively evaluating
The original plan was to investigate breed as a potential risk sample submission-based datasets. Importantly, the lack of
factor reflecting management practices; however, accurate infor- unique identification of horses in Canada, along with the fact
mation about breed was missing in many cases and horses of the that a substantial proportion of records in the database con-
same breed (e.g., Thoroughbreds) may have been managed quite tained limited, conflicting or missing information, complicated
differently (e.g., as riding horses or racehorses). Similar breeds, identification of individual horses and categorization of horses
therefore, were grouped into larger categories and based on this for the purposes of risk factor analysis. Improved traceability
grouping, breed type was not associated with disease risk. Aside and identification of horses undergoing EIA testing would likely
from the inherent limitations of our breed type categorization, facilitate further research, and may even be useful in the context
any effect of breed may also have been removed as individual of disease investigations.
breeds tended to cluster by owner, again suggesting that proxim- In conclusion, our study showed that the majority of horses
ity to EIA cases was a stronger risk factor than the individual with EIA during the 4-year study period were detected based
animal characteristics. on disease investigation testing of in-contact horses. Our data
Sex was not identified as a risk factor for EIA in this study, further suggest that seroconversion of additional horses can be
which is similar to previous reports (19,23,24). There are expected once a disease investigation commences, and that most
no inherent biological reasons why disease risk should dif- horses found to have EIA in Canada are subclinical carriers.
fer between the sexes; however, sex-dependent differences in Within a subpopulation of high-risk animals, age was identi-
behavior or management practices might still increase the risk fied as a significant animal-level risk factor for EIA. Additional
of contracting EIA. In wild horse populations, an increased research is needed to investigate all potential modes of virus
risk of EIA for stallions has been suggested (25) and may be transmission during disease outbreaks, and to evaluate the
explained by a transfer of blood or saliva during stallion fights. impact of management practices on disease risk in Canada. CVJ
Interestingly, age was a significant risk factor for EIA in our
study, with horses in the 3 oldest age groups having a signifi- Acknowledgments
cantly increased risk compared to the youngest age category. The authors gratefully acknowledge Maria Funk, Hayley
The data herein are consistent with 1 previous study showing Kosolofski, and Thuy Nguyen for their assistance with data
an increased risk of EIA in older horses (19) and may reflect cleaning. CVJ

an increased “lifetime” risk for exposure to EIA by both natural


and iatrogenic routes in older horses. As our study evaluated
References
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Book Review
Compte rendu de livre

Lavin’s Radiography for Veterinary “Application Information” boxes and “Technician Notes” have
Technicians, 6th edition been added, which provide practical information for on-the-job
challenges. There was quite a bit of mention about working
Brown M, Brown LC. Elsevier, St. Louis, Missouri, USA. 2018. with film and developing film, and while I’m sure there are still
627 pp. ISBN: 9780-3234-1367-1. some clinics working this way, I feel that most clinics have now
switched to digital X-ray, so in my opinion it may have been

T his book is a great addition to any clinic’s library. It con-


tains an absolute ton of information starting with how
an X-ray machine works and where it gets its power from, to
appropriate to focus more on this aspect.
There are informative chapters on avian and exotic, and
equine and large animal radiography, which provide informa-
a multitude of different specialized imaging options. It covers tion on positioning and restraint for the X-rays. The authors
the when and the how of quality control for X-ray machines, also mention different tools to help with the positioning and
which is great for both practices and technicians who are just restraint techniques to get the best possible results. Overall I
starting out. There is a fantastic group of chapters about small think that this is a great book. It has educational information
animal positioning for abdomen, thorax, forelimbs, and hind and is very in-depth. I would recommend this for any veterinary
limbs, all the way to vertebrae and skull. They’ve also included clinic because it’s always useful to be able to have a reliable and
information on options for restraint and tools and tricks to informational resource when needed.
help reduce radiation exposure to staff. Sample radiographs are
provided along with footnotes to help the reader visualize and Reviewed by Kelly Buker, RVT, Hart Family Veterinary Clinic,
follow along in the text. Prince George, British Columbia.

1206 CVJ / VOL 60 / NOVEMBER 2019

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