In our August issue, we reported the growing concern around Brucellosis in foreign dogs – and how a growing number of veterinary practices are refusing to treat dogs from overseas unless they’re first tested for the disease. Louise Buckley, a former registered nurse, has removed herself from the Royal College of Veterinary Surgeons’ nursing register in protest…
I am a university academic with a background in animal welfare assessment and evidence-based veterinary medicine and, up until May 2023, I was also a registered veterinary nurse. In May I removed myself from the Royal College of Veterinary Surgeons’ nursing register in protest over the veterinary profession’s handling of overseas dogs in respect of Brucella canis.
Over the last couple of years there has been a growing attempt by the veterinary profession to retrofit demands for pre-import testing for Brucella canis upon the many thousands of overseas dogs that are already living in the UK, some for as long as 10 years or more. Owners have often been effectively made to test or face withdrawal of vital veterinary care services for the dog and, often, other animals within the household.
I have spent this year campaigning against the spread of this fear-based medicine and believe that it has no place in veterinary practice in the 2020s
Yet, the tests being used are not suited to confirming the presence of disease (they are screening tools only), but are being used in this way with grave repercussions for affected families. I believe that it is poorly evidence-based and has led to numerous welfare challenges, unacceptable levels of suffering for some dogs and heart ache for affected owners. You can read the many experiences reported in the August edition of Dogs Today, or in the testimonies provided on my own Facebook page.
What they all have in common is the suffering these owners and dogs have experienced is not usually from the disease itself but from the current fear of this disease and the consequences this has had for how owners of overseas dogs that test positive are treated. Whilst this disease is an infectious zoonotic disease it needs to be put in the context of the wide range of diseases that currently fall into this category and for which we continue to provide veterinary care for.
For example, how many readers realise that Bordetella bronchiseptica, a common cause of kennel cough, can infect susceptible owners and cause significant illness? There will always be a range of risks associated with owning or working with dogs, and Brucella canis needs to be set within the wider context of risks. As zoonotic infectious diseases go, it is a relatively tame one, that appears to be low risk for spreading to humans, and when it does, in most humans appears to cause either no symptoms or mild self-limiting (no treatment needed) symptoms.
Very occasionally in susceptible people it seems to cause more severe disease. In the case of dog to dog non-reproductive transmission, the available evidence is suggesting that the risk of transmission between neutered dogs in a pet dog setting is likely to be low to negligible. Indeed, John McGiven, the Animal, Plant & Health Agency (APHA) Brucella expert speculated at a recent conference (Official Veterinary Conference 2023), that if infected dogs were neutered it was unclear that the disease could be sustained in the absence of reproductive distribution.
To return to human health care risks, Brucella canis is a bacteria that was first identified back in the 1960s and is endemic to many parts of the world. Yet, despite the worldwide distribution of this pathogen there have been no deaths reported in the literature, and we are largely working on a handful of case studies, none of which, it is important to note, implicate this pathogen in any pregnancy or fertility related issues for women.
Furthermore, at the time of writing this letter, there is only one veterinary profession reported to have become infected in the UK from Brucella canis and they remained symptomless. Despite this, owners are frequently strongly encouraged, under threat of withdrawal of veterinary care, to have their dog tested for Brucella canis, on the grounds that it is a major threat that has caused deaths and disability to UK veterinary professionals, and will prevent women from successfully carrying children. I have spent this year campaigning against the spread of this fear-based medicine and believe that it has no place in veterinary practice in the 2020s.
The risk has been assessed as ‘very low’ for the general human population, and ‘low’ for those at greater risk of exposure to infectious material
I am delighted to say that the government now appears to agree with me. On 18 September 2023, the UK government’s Human Animal Infections and Risk Surveillance group published their revised risk assessment on the threat that Brucella canis poses to human health. The risk has been assessed as ‘very low’ for the general human population, and ‘low’ for those at greater risk of exposure to infectious material.
Moving on to the testing regime. It is important to note that the current recommended testing approach is effectively a cull policy type approach, more commonly utilised worldwide for low value livestock rather than much loved family pets, and in America, this approach is not taken to Brucella canis. A cull policy takes the approach that it is more important to identify as many dogs as possible that do have the disease, and accepts that there will inevitably be potentially high levels of collateral damage in the form of dogs wrongly labelled as diseased.
This very much applies to the current situation where, based on the government’s own reported figures, as many as 50% of dogs that test positive could be a false positive. It is worth noting that if all overseas dogs in the UK were tested for Brucella canis, around 9,000 – 18,000 would be wrongly identified as being sero-positive for this disease and recommended for euthanasia. If we screened all UK dogs, this number would jump to 120,000 – 240,000k ‘false positives’ and I believe this is completely unacceptable for a disease that has now been demonstrated to be of very low – low risk to humans, and likely similar where dogs are neutered and removed from the breeding pool.
I was very disappointed to see that the current British Veterinary Association senior vice-president was reported as saying that the test “can be repeated to confirm a positive result”. Owners need to be aware that they are being lulled into a false sense of security here and it is NOT good practice to repeat the same test in order to rule out a false positive and it is critical that both veterinary leaders and veterinary professionals in practice improve their understanding of the statistics around diagnostic testing.
Whatever substance caused the test to be positive the first time round, will continue to cause a positive result on the second occasion if it is still present in sufficient quantities at the second test. This is true, regardless of whether the substance was Brucella canis antibodies (a true positive) or another substance that cross-reacted (a false positive). Repeat testing using the same test only realistically has value when monitoring disease progression, or where there is a suspicion of laboratory error. So far this year, by July laboratory error at the APHA testing facility resulted in around 10 dogs being wrongly reported as positive, of which 2 sadly lost their lives before the error was realised.
I also take issue with the claim that this is not a curable disease. The reality is that we do not know for certain either way. We know that some dogs that are treated with antibiotics go on to have recurring clinical signs so not all dogs respond to treatment. We also know that this bacterium likes to hide in cells within the body where it is difficult to reach with antibiotics. However, we also know that some dogs did not go on to have recurring infection during the period of monitoring.
I am calling on Dogs Today readers to play their part in helping to encourage the practice of evidence-based veterinary medicine
Furthermore, there is some evidence that dogs left to naturally fight the infection (i.e. no antibiotic treatment) appear to spontaneously recover (i.e. their own immune system clears the infection) albeit that it can take months to years to do so. If readers are interested in finding out more I highly recommend the classic veterinary textbook Greenes’ Infectious Diseases of the Dog and Cat.
However, owners ought to told that there is this uncertainty here and that the tests that are currently used are not proof that the dog is infected. Serology tests are used because the bacteria is difficult to identify using direct methods, but serology tests only look for evidence that the dog has been infected at some point. If I looked for antibodies to Covid-19 in humans, many humans would have these, but few would be currently infected.
The gold standard for diagnosing Brucella canis in humans is a blood culture because this is direct evidence of current infection, but owners of sero-positive dogs in the UK are not being given this information or option in many cases. Since I went public with my concerns it is noticeable that none of the veterinary organisations (RCVS, BSAVA, etc), government agents (e.g. DEFRA), or charities (e.g. Dogs Trust) have spoken out against my claims. Indeed, I have it in writing from several of these organisations that the risk of false positives could be very high.
I am pleased to note that the major veterinary organisations are now collaborating to produce a new position statement/policy in the light of my concerns and the revised HAIRS report, and also that several veterinary corporates have now produced revised policies for the testing and care of overseas dogs that better reflects the risk.
However, there is still a significant way to go before overseas dogs are receiving the veterinary care that they should be receive in 2020s UK veterinary practices, and I am calling on Dogs Today readers to play their part in helping to encourage the practice of evidence-based veterinary medicine by printing off a copy of the HAIRS report, reading it, and then dropping in a copy to your local veterinary practice marked for the attention of the clinical director.
It is time to stamp out fear-based medicine and refocus on ensuring the welfare of overseas dogs imported into the UK, and if we all stand together on this we can make that difference and turn the tide.