Owner education in year-round prevention of fleas and ticks

A study by the University of Salford has found ticks are presenting a year-round problem in the UK (Sánchez-Vizcaíno et al, 2016), by demonstrating they continued to quest in woodland during winter.

It was previously considered ticks were inactive or dormant during this time.

Additionally, Public Health England reported an infestation with the brown dog tick in a house in Essex in 2014. Despite repeated treatment of the environment and dogs, ticks were still being found – suggesting an established population capable of overwintering (Hansford et al, 2015).

Patterns of disease can evolve quickly with increased exposure to parasitic vectors. This new evidence of increased prevalence of ticks – together with the well known, year-round issue of survival of fleas in the environment – highlights the need for regular ectoparasitic treatment.

The time when UK vets and pet owners felt isolated and safe from the threat of continental disease appears to be over, with the presence of global warming and increased frequency of travel by both humans and pets. Reports of canine babesiosis in Essex would be one example of novel disease present in an animal population that had not travelled abroad directly (Woodmansey, 2016).

Increasing owner awareness of the importance of using appropriate treatments – and dealing with compliance issues for owners already using products – are essential for both pet health and practice profitability. On average, 50% of veterinary business comes from non-professional fees (Gerrard, 2014), so retail is an essential component of business.

Retail increases sales, encourages clients to come into the practice, provides a good experience, promotes the practice image, offers a perception of quality, and provides the chance for professional recommendation (Gerrard, 2014).

The ectoparasiticide market is crowded, with new products being launched regularly. As a result, a wide choice is available, giving owners and practices an unprecedented choice. While this can seem only good for customers, too much choice can result in clients feeling overwhelmed and not buying anything.

Additionally, staff familiarity with brands may be reduced; therefore, they may not be able to correctly recommend stocked products.

Compliance issues are a large factor in treatment failure, while owner education is key for success. Despite the frequent introduction of new compounds in the treatment of flea and tick infestations, parasites continue to be a frequent cause of discomfort and disease transmission.

What do vets and owners want from products?

Treatment efficacy

The most obvious requirement is vets want the products they sell to have a high level of efficacy against the chosen parasites. POM-V products have undergone a variety of studies to provide efficacy data. Educating owners regarding efficacy is imperative to aid understanding of the difference between these products and cheaper, less efficacious products.

Broad spectrum

Many products are targeted against multiple parasites for owner convenience.

Understanding what an owner wants from a product is essential for him or her to buy it regularly. Some may want a combined tick and flea treatment, while others may be more concerned about, for example, fleas and angiostrongylosis.

Repellent efficacy

A product that repels parasites from attaching to the animal means disease transfer risk is severely reduced.

Environmental control

Use of insect growth regulators prevents larvae from hatching – reducing environmental contamination and overall parasite numbers. The direct application of chemicals to the environment is still a popular option.

Duration of action

Some owners find monthly applications easy, whereas others require longer-acting products for convenience.

If owners forget, this can lead to parasitic reinfestation and outbreaks of disease. Although it is not the product’s fault, owner dissatisfaction is likely to occur and could lead to loss in revenue.

Cats and dogs

Using the same brand in both cats and dogs could be important for some owners and can be more practical.

Formulation of product

Some owners may prefer topical application or oral medications, while some animals may be intolerant of one mode of administration.

Safety of use

Owners want to only use products safe for their animal. Many collie owners may be aware of the sensitivity to avermectin compounds, for example, but others may be unfamiliar and require direction.

An essential part of staff sales should be educating owners regarding permethrin toxicity in cats. Educating owners in the clinic could help avoid accidental application of products, including those bought elsewhere. International Cat Care has been campaigning for improved regulation of permethrin products – calling for reclassification of these products, with clearer labelling and warnings on packaging about inadvertent use on cats. Posters and information are freely available.

Increasing owner awareness of products

Numerous methods can be used to increase owner awareness of products.

Staff knowledge and advocacy

Ensuring staff recommend parasiticides is essential for generating revenue. Staff can politely ask whether clients would like to buy products. Clients frequently intend to buy after a consultation, but forget to ask at the time – meaning potential revenue is lost.

Little point exists in stocking an array of premium products and using promotions if staff do not understand the products. Training is essential to ensure everyone makes the same recommendations regarding suitability of products for each pet.

It is also important staff have a basic understanding of flea and tick life cycles to advise owners regarding, for example, correct treatment of environmental flea and larvae contamination, and avoidance of tick habitats.

VN clinics

Nurse clinics are an excellent way to deliver preventive health care and increase practice profits. This may be through, for example, free flea checks, puppy/kitten checks and parties, second vaccinations, and weight clinics. These provide opportunities to promote the practice message and boost retail sales, particularly where VNs are also SQPs.

Offering a service to administer flea, tick or worming products to patients can help clients who may find it difficult due to mobility issues or non-compliant pets.

Pet health plans

Health plans help secure revenue and improve compliance. Research has shown clients will spend more money on preventive services once they are on a plan, compared to not being on a plan and buying ad hoc (Goulding, 2011; Westgate, 2014).

Successful pet health plans improve client loyalty and compliance, increase footfall and spend, and attract new clients (Goulding, 2011).

Practice promotions

Waiting room and consulting room displays can remind and educate owners about products.

Provision of interesting, up-to-date displays and leaflets – or a visual display unit – are essential tools for promotion of products. Having these in an easily visible area, and using point-of-purchase locations, will allow clients to take in the promotional message.

Promotions on multiple treatments encourage product uptake and can increase compliance with recommended regimes.

Social media

Maintaining a presence on social media is becoming more important in the digital age. Many owners are turning to the internet for advice, rather than picking up the telephone.

Most practices have a Facebook page, but many do not use it to its full potential. The page can recommend products and advise of promotional offers, and educate the public.

National media campaigns

Being aware of drug companies’ advertising campaigns can provide a useful link to practice products, and allow practices to take advantage of owners’ increased awareness of diseases and/or products.

Compliance issues with use of treatments

Failure of owner compliance will reduce the efficacy of treatment recommendations made in the practice. This will lead to owner lack of confidence in the recommendations, reduced retail spending and potential consequences to animal health. Therefore, improving compliance is essential.

It is important for staff to be able to identify common causes of treatment failure to be able to address and correct this with owners (Panel 1). Making clients aware of potential consequences of treatment failure can help understanding and compliance (Panel 2).

Owners frequently report failure of the prescribed medication to work and a perceived resistance to the drug. Studies have shown most efficacy issues are due to failure to treat correctly (Panel 1; Dryden et al, 2013).

Additionally, heavy flea infestations may take at least three months to eradicate, even when environmental treatment is used (Dryden et al, 2000). Therefore, management of owner expectation is another important challenge.

Considerations

Vets have numerous considerations when recommending a parasite control programme.

Animal

The age and health status of the animal, including its history and origin, need consideration. Debilitating diseases may also play a role, by rendering dogs and cats more susceptible to parasitic infestations – for example, lice infestation is more common in kittens and/or very old, debilitated or immunocompromised animals.

Environment

Dogs that live in kennels, outdoors and with other dogs or cats – and stray and hunting dogs – may be at greater risk of acquiring external parasites, so may require special consideration. The same holds true for cats living in catteries, stray or feral cats, and cats living with other cats or dogs.

Nutrition

Poor nutrition may contribute to susceptibility for heavy infestation with external parasites and/or clinical symptoms.

Location and travel

Animals living in, or travelling to, specific areas – for example, for holidays or relocation, boarding facilities, dog and cat shows, and field trials – may be at increased risk of acquiring infestations occurring in these areas.

Pet and pet owner lifestyle

Pet and pet owner lifestyle may play a part in the likelihood of the acquisition of external parasites. For example, dogs and cats that visit, or live close to, rural woodland areas may be likely to be exposed to some tick species.

Reinfestation with fleas from outside the home environment may occur more readily in urban areas, where cat and dog population density is likely to be highest.

Infestation of fleas – especially in multi-animal households – may be more difficult to eradicate, and expense can be an important consideration in these cases (European Scientific Counsel Companion Animal Parasites [ESCCAP], 2018).

Flea and tick prevention protocols

Flea treatment products can be divided into adulticides (killing adult fleas) and insect growth regulators (preventing development of larvae or eggs), with some formulations combining both in one product. A wide choice of products are available on the market, including topical, oral, spray and collar types.

The best flea control results can be obtained via the implementation of an integrated flea control approach (Elsheikha, 2016):

• using an effective, long-lasting adulticide to kill fleas on the animal
• using an insect growth regulator to prevent the development of flea eggs, larvae and pupae in the home
• using mechanical control methods – such as vacuuming carpets, furniture, cushions and rugs regularly, increasing heat and humidity within the home, and washing the pet’s bedding (warmer than 60°C)
• raising awareness with owners of the understanding of the flea life cycle in the home

Tick treatment products can be divided into acaricides (killing ticks once they have made contact with a treated animal’s skin) and repellents (containing ingredients that help prevent tick attachment). A number of formulations are available.

The goal of effective treatment is to prevent both infestation and disease transmission, as the longer the tick spends feeding on the host animal, the higher the chance of pathogen transfer.

Most tick prevention programmes involve:

• Habitat modification – for example, burning tick habitat or leaf litter.
• Avoiding tick habitats – heavily wooded and grassy areas – from March to June, and August to November, when tick numbers are increased.
• Frequent tick checks (at least one every 24 hours) to locate and remove ticks before they can transmit disease. A study by Smith et al (2011) found 23% of dogs had ticks, often without the owner’s knowledge. Specific tick removers should be used to remove the tick and its mouthparts successfully.
• Use of anti-tick products (Elsheikha, 2016).