Moving from information and collaboration to action: report from the 3rd International Dog Health Workshop, Paris in April 2017

Breed-specific health strategies

Breeding advisors, breed clubs and individual breeders frequently struggle with two main issues. First, how to define and understand the ‘big picture’ for their breed in terms of disease, genetics, population numbers, breeding and general management. Second, how to process all the complex inputs that affect the health and welfare of their dogs. Without access to full information, adequate evidence or effective tools to define the big picture, stakeholders tend to view challenges more narrowly and in the shorter term. This may mean that they end up running after the DNA ‘test of the month’ or imposing knee-jerk reactions to media storms that may lead to breeding strategies that change again as soon as the executive of the breed club changes. Optimal and selected approaches to managing health and disease at a breed level also vary widely across countries, kennel clubs, breed clubs and breeds. It is therefore important to build on experiences from these different countries and groups, in order to facilitate exchange and collaboration, harmonize health assessment and screening programmes, and suggest optimal strategies and health strategies for use at the breed level. This was the background to the session on breed-specific health strategies.

The participants in the session were truly multi- and inter-disciplinary, and included geneticists, veterinarians, epidemiologists as well as breeders, owners and dog-health campaigners. With 34 participants, this was the most popular stream at the workshop. Ian Seath (UK), Chairman of the UK Dachshund Breed Council [25], shared his experience based on the approach taken by his breed council and stressed the importance of applying accepted business management elements including leadership, planning, engagement and improvement.

The group agreed that effective and sustainable implementation of health strategies requires innovative solutions to many different challenges. Provision of sufficient and reliable information was agreed as critical, for both situational assessment as well as day-to-day screening of dogs. On the one hand, a diversity of survey templates for breed health assessments have been developed and are available for individual breeds [26]. On the other, veterinary screening programmes and diagnosis-based research requires harmonization across breeds for effective application in health programmes, especially at an international scale. Considering the design of health strategies, the group decided that it was important to identify and balance the major issues for each individual breed and give guidelines on how priorities could be determined for each [4], while still allowing breeders discretion to make their own decisions within an overall framework of requirements and recommendations. The group agreed that it would be useful to develop a model to evaluate generic breed problem categories (e.g. inherited disorders with DNA test available, multi-factorial conditions with existing screening programmes) in order to define breeding strategy solutions (e.g. breeding recommendations based on DNA tests adapted to disorder prevalence, development and use of estimated breeding values (EBV)). Importantly, the group also concurred on the deleterious consequences of inappropriately removing dogs from the breeding gene pool when breeders failed to understand the conflicting influences and effects that may arise from disease control strategies versus a need for genetic diversity.

The group considered that achieving compliance by breeders and owners to recommended or required screening and breeding guidelines was a challenge for breed-based health strategies. Imposition of mandatory screening programmes and open registries of test results as a prerequisite for kennel club registration could result in breeders choosing to breed non-registered dogs instead. However, lack of adherence to programmes and incomplete data pose significant barriers to achieving health improvement. This underlined the importance of education and communication between the different stakeholders (including breeders, owners, veterinarians, geneticists and judges) in the design and implementation of effective health strategies.

The group discussed their diversity of experiences across countries in relation to breed-specific health strategies and access to their local resources and tools that could be shared more widely. The use of the DogWellNet.com platform website as a repository for such resources was recommended. The general conclusion was that there is no “one size fits all” solution for developing breed-specific health strategies and that the most effective interventions would be adapted according to the specific context of each breed [27]. The impact of national cultures on successful approaches can be significant. For example, the Nordic countries enjoy a culture of regulation and compliance from breeders and have advanced breed-specific strategies in place. However, a similar regulatory approach would risk driving breeders away from their kennel club’s sphere of influence in other locations (e.g. the Benelux and Southern Europe regions).

The group felt that a more holistic approach to breeding was needed, with greater focus on population-specific situations and reduced emphasis on breeding decisions based solely on single diseases and DNA tests. To that extent, the group considered that it was inadvisable to conduct health strategies within individual breeds focused on single diseases independently from a more broadly focused breeding strategy. The participants agreed to set up a working group, led by Jerrold Bell and including 12 other participants from the workshop, to take forward the ideas discussed and to create a set of resources and tools that could help breed clubs to accelerate the creation and more importantly, the implementation, of strategies that benefit their dogs. Subgroups from this working group will also work on the development of breeding strategies for specific breeds, such as the Bernese Mountain Dog and Dachshund.

Exaggerations and extremes in dog conformation

As the popularity of small-sized flat-faced breeds continues to increase around the world, the health and welfare of brachycephalic breeds has become an increased priority issue. Rowena Packer (UK) outlined current understanding of health consequences from extreme brachycephaly in her plenary presentation and described mounting evidence of breathing, thermoregulation, eye, skin, spinal and birthing problems associated with this phenotype [28–32]. In consequence, this theme elected to focus exclusively on brachycephalic health, with specific emphasis on breathing problems (brachycephalic obstructive airway syndrome; BOAS) that were considered the most severe welfare concern in brachycephalic breeds [33, 34]. However, key points of the discussion also relate more generally to other issues of exaggerations and extremes.

Discussions across the 27 participants covered both current efforts, such as the formation of brachycephalic working groups in the UK [35] and by the Nordic Kennel Union [36], whilst also debating alternative future strategies. Although kennel clubs have developed initiatives to improve brachycephalic health (e.g. ‘Breed Watch’ in the UK [37], ‘Breed Specific Instructions’ in the Nordic region [38]), significant challenges remain. It is increasingly clear that the brachycephalic issue is largely a ‘human’ problem, with change hindered by frequent ‘blindness’ to the health problems in these breeds, and ‘normalization’ of their health issues [39, 40].

The working groups are committed to these actions, and joint coordinator Kristin Prestrud has presented these plans at the WSAVA/FECAVA congress 2017 [43].

Education and communication of antimicrobial resistance

The emergence and expansion of antimicrobial resistance (AMR) has been widely documented and challenges current antimicrobial therapy protocols. It has increased human and veterinary treatment costs and patient morbidity and mortality [44, 45]. AMR is geographically widespread and can be transmitted between humans and animals [46, 47]. AMR remains a challenge in veterinary medicine with limited and differing guidelines across countries that results in fragmented communication and education approaches.

The AMR theme subgroup reviewed selected materials covering national AMR guidelines [48–51], antimicrobial prescribing pressure in healthcare [52], and AMR transfer between people and companion animals [53] prior to the meeting. The conference plenary presentation from Jason Stull (US) further explored these topics and highlighted issues such as unnecessary/inappropriate antimicrobial prescribing in medicine, lack of studies addressing usage in breeding dogs, and stressing the importance of targeting behavioral change in antimicrobial use at multiple levels (i.e., intra-personal, inter-personal, community, institutional) [54–56].

The subgroup included 13 participants representing five countries from sectors including academia, veterinary medical associations, private practice, pet insurance, kennel clubs and foundations. An initial presentation reviewed actions taken in France to address AMR in companion animals, including development of surveillance collaboration with veterinary practitioners and laboratories (RESAPATH) [55], recent policy and law to reduce usage of critically important antimicrobials, guidelines to promote prudent antimicrobial use, and training and campaigns to create awareness. Following these efforts, a 20% reduction in antimicrobial use in animals was observed (2011 to 2015; estimated to be 10% reduction in dogs and cats) [56]. Other countries have employed similar approaches with comparably successful outcomes [57].

Challenges discussed to replicating the French model in other countries included limited stakeholder buy-in, strong lobbying groups, resistance to top-down approaches, and varying backgrounds of breeding groups across countries. Additional challenges included sustaining and enforcing prescribing requirements and antimicrobial use reporting. Lack of published antimicrobial usage and AMR data in breeding dogs and limited prudent-use guidelines for breeders and veterinarians were considered major limitations. Participants agreed that veterinarians should work collaboratively with breeders to effect change and that a multi-national educational approach aimed at breeders was needed to unify groups and drive positive change.

Given international differences in culture and infrastructure, it is perhaps unsurprising that there is currently a fragmented approach to addressing AMR in dogs across country/region and stakeholder groups. The discussions of this multi-stakeholder international group highlighted the limited information currently published on this topic in breeding dogs and that a unified approach is required to capitalize on current successes and resources. This conference and resulting working groups are an excellent step toward these concordant efforts.

Behavior and welfare

Socialization of puppies at appropriate ages is considered critical for optimal behavioral development of dogs to facilitate their life as pets within human homes. Dogs with appropriate behavioral responses are more likely to remain with owners or adopters, thereby strengthening the human-animal bond and promoting animal welfare and human well-being. Conversely, dogs that display undesirable behaviors may have compromised welfare driven by their underlying emotional motivations for the behavior (e.g. anxiety) or from how owners/adopters might seek to achieve resolution (e.g. aversive techniques, relinquishment) [58–60].

A thought-provoking plenary talk from Paula Boyden (UK) entitled The intersection of welfare and behaviour in dogs and relation to health and breeding set the tone for the theme by focusing on socialization in puppies. Some complex interactions across this topic were highlighted including selection for physical features that may limit expression of normal behavioral communications with dogs and people, and early life experiences that impact later health and welfare and influence human-animal interactions. Examples of puppy programs that support development of positive health behaviors were also described.

The theme included 15 participants with diverse backgrounds from eight countries (France, Sweden, Switzerland, Finland, Germany, Ireland, UK, and USA). The group explored knowledge and beliefs around several aspects of puppy socialization that relate to later behaviors and animal welfare. Topics discussed included the critical sensitive period for socializing, evidence for outcomes with different socialization methods, potential breed differences, gaps in knowledge, access to international literature on the subject, existing programs that might be replicated/tested, correlations between puppy testing and future outcomes of behavior, educational needs for new owners, and educational needs for breeders and other stakeholders.

Throughout the workshop, the information and experiences shared by participants were highly instructive and led to shared goals for international collaboration. The group agreed that puppy socialization has many important requirements, from providing excellent prenatal care, to minimizing stress throughout pregnancy and minimizing fear with proper housing, addressing critical times for introducing puppies to novel environments/people, and determining the evidence/outcomes for various methods utilized. While proper socialization should not be considered the only criterion for producing healthy puppies, it was deemed necessary for developing a dog with good behavior and a better chance for a good life.

IPFD harmonization of genetic testing for dogs

Increasing demand for genetic testing has led to a boom in for-profit and non-profit, commercial and academic genetic test providers (GTPs) and available tests [61]. Defining “good quality” GTPs and DNA testing, in the current absence of independent regulation, is almost impossible for dog owners, veterinary scientists, and breed/kennel clubs [62].

In parallel with an increase in breeding policies incorporating genetic testing [63], there are no standards, regulations, or quality control metrics for GTPs providing DNA testing in veterinary medicine. Along with anecdotal experiences of poor GTPs, this brings genetic testing in dogs broadly into disrepute, and disincentivizes conscientious GTPs to maintain high standards. Even in human testing, serious questions are raised about the regulation of medical testing [64].

In response to, and building on discussions at the 1st IDHW and 2nd IDHW, the IPFD is overseeing the development of an online resource of relevant information from GTPs describing quality measures (QMs) for DNA testing. Further development into 2018 will include platforms for expert reviews of tests; coordinating a proficiency testing scheme, and genetic advice and education. The model depends on GTPs and multi-stakeholders participating voluntarily. An open-access prototype was developed using data provided by GTPs indicating a spectrum of initial QMs, from international accreditations to customer care. This centralized resource aims to aid kennel/breed clubs, breeding advisors and owners to make better informed decisions on GTPs and testing.

The 34 theme participants included representatives from GTPs, geneticists and researchers, kennel clubs/registration bodies, and owners/breeders. In preparation for the 3rd IDHW, theme participants were provided with a reading list including the prototype description, and recommended websites of similar systems in human/non-companion animal testing (www.dogwellnet.com, www.eurogentest.org, www.orpha.net, www.icar.org, www.acmg.net). Objectives for the workshop were to encourage stakeholder engagement with the project and to identify experts/ participants for future development of the platform.

Following a plenary presentation from Aimée Llewellyn-Zaidi (US), the theme discussed issues including the independent evaluation of GTPs, individual DNA tests, and genetic advice. The group accepted that most genetics experts affiliate with at least one GTP and therefore may not be truly unbiased. To address this, the IPFD was identified as an independent organization capable of leading a strategy of balanced and collaborative compilation of quality information on GTPs.

The group felt that building a definitive list of current QMs and GTPs was paramount. An agreed action was to host this list on DogWellNet.com (expected early 2018). Concerns were raised on standardizing QMs across international boundaries and laboratory types (i.e. commercial vs. primarily research laboratories). The result was to form a working group of multi-stakeholders and laboratories to be hosted on a DogWellNet.com forum.

Future priorities included development of a proficiency testing scheme and collation of resources for genetic advice. This lead to forming working groups to address evaluation of genetic testing, advice, sustainability, and proficiency testing. Leaders for each working group are experts in relevant fields, and a balance across stakeholders was determined. External experts would be sought where relevant.

The group considered that the lack of accreditation and standardization across DNA testing is putting the health of dogs at risk. Without adequate guidelines, or external validation, consumers risk making detrimental breeding decisions based on irregular results, or fraudulent activities. Without consumer confidence in DNA testing, GTPs and researchers will struggle, and preventable inherited diseases will continue. The group agreed that the Harmonization of DNA testing for Dogs project, is a major step towards engaging with GTPs, and experts, to improve use of DNA testing.

Show me the numbers: Integrating information from various sources for prevalence, risks and other population-level information

Data-deficiencies are widely acknowledged to constrain improvement in companion animal health [15]. A demand for more and better data was identified across each of the other five themes with a recurring message that actions should ideally be based on good evidence wherever possible. The Numbers theme aimed to identify opportunities to increase the availability of data in order to improve dog health. With 14 participants from six countries, the Numbers group benefitted from inclusion of leading representatives from academia, animal insurance, kennel clubs, data analysis, laboratories and business, enabling discussion on a wide range of data topics.

These four main data areas were also echoed from each of the other themes. Some additional numbers-based comments from the other themes included the value of longitudinal evaluation of breed health to assess the impact of programs and that data collection efforts (e.g. breed club health surveys, antibiotic use and AMR, behavioral assessments) need to be enhanced and coordinated. Additional actions to facilitate progress on all identified needs included publishing data results, for example in CGE; creating a meeting place for people who have data or questions regarding data on DogWellNet.com; and exploring funding for knowledge sharing and working together on an international level.