Contagious Equine Metritis

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Contagious Equine Metritis

• Michaela Kristula, DVM, MS

Many Species. One Medicine.
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Some color and symbol codes

• Grey proposed by CEM review group
• asterisk - things I do
• Always okay to do more

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Testing procedures for CEM

• Horses arrive in sealed vans from Newburg
• Consensus - Seals useful
• CEM state coordinators should be informed of
  arriving horses

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Proposed minimum standards

• Housed in individual stalls
• One empty stall between CEM quarantine horses and
  other horses prevent direct contact
• Groups of horses (Gypsies) can be kept in same
  paddock together (housed together before shipped)
• Test mares separated after breeding

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Helpful farm policies

• Individual water and feed buckets
• cleaned daily
• Isolation barn for sick horses
• Monitor for feed intake and manure
• Temperature daily
• Concerns EHV1, Strangles, Influenza
• Inform CEM state coordinator if hospital referral
  required
• Facilities should not harm horses

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Proposed minimum standards

• Facility managers and laborers should have
  experience with horses and be familiar with
  equine reproduction
• Understand risks of transmission through
  contaminated techniques
• Use separate gloves for each mare and procedures
• We use plastic bags in buckets

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Helpful

• Mares
• One person to hold mare
• One person to hold tail
• Stallions
• One person to handle stallion
• One person to handle test mares
• One person to assist breeding
• ( Vet and state CEM coordinator)

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Import mare procedures

• 3 sets of clitoral sinus and fossa cultures
• Interval 3 days between cultures
• Current regulations - 1, 4, and 7 days of a 7
  day period
• Proposed guidelines
• Complete cultures by 12 days after 1st
  culture
• Accommodates holidays and weekends

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Culture sites mares
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Culture sites mares
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Proposed extra site for import mares

• One cervical or endometrial sample as part of one
  of three sets
• Intrauterine pipette
• Palpate mare for pregnancy- If endometrial sample
• Take sinus and fossa culture first
• Okay to use Chlorhexidine 4 scrub to clean mare
  after 3rd culture

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Import mares - after third cultures Day 1/5

• Flush beans from clitoral sinuses with Cerumene
  (6-10 cc syringe)
• Use 4 Chlorhexidine Gluconate scrub to flush
  sinuses (10 cc syringe)
• Scrub sinus and fossa area with 4 Chlorohexidine
  scrub
• Pack with .2 Nitrofurazone ointment

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Flushing beans with Cerumene
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Flushing beans with Cerumene
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Import mares procedures - Days 2-5

• Scrub sinus and fossa area with 4 Chlorhexidine
  scrub
• Pack with .2 Nitrofurazone ointment
• Mares released 7 days after 3rd set of cultures
  are read as negative

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Import mares - Proposed CF test

• Proposed that import mares get CF test for CEM at
  import centers
• ??

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Import stallions - Procedures

• 3 culture sites
• Urethal sinus, fossa and prepuce
• Tease or tranquilize (200 mg Xylazine IV)

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Stallions culture site urethral sinus
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Stallions culture site urethral sinus
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Stallions culture sites - Fossa
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Stallions culture site - prepuce
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Stallions culture site - prepuce
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Stallion - Proposed 4th culture site terminal
urethral
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Stallion - Proposed 4th culture site terminal
urethral
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Culture handling

• Special media Amies charcoal media
• Refrigerate right away (4º C)
• Needs to arrive to lab within 48 hours
• Approved lab
• Cultures read at 7 days after plating
• Proposed clarification read by hours -168 hrs
  vs 7 days

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Test breeding of stallions

• After negative cultures at least 7 days
• Breed stallion to two qualified test mares
• Clean vulva and place tail bandage on test mare
• Tease stallion before breeding to see if test
  mare is in heat
• We clean penis with water and dry (on occasion
  if filthy) before breeding ??
• Need 20-30 minutes between breedings

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Teasing
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Teasing
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Test Breeding Veterinarian and state CEM
coordinator attend breeding
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Scrub (Chlorhexidine 4) and pack (Nitrofurazone)
for 5 days after breeding
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Test mare schedule after breeding

• Culture sinus and fossa 3 times at 3 day
  intervals after breeding
• Proposed Complete cultures by 12 days
• postbreeding
• Proposed extra culture site
• Cervical or endometrial
• CF test at 15 days post breeding
• Send CF test to either Cornell or NVSL
• Proposed CF test at 21 days post breeding

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Import stallion release

• Negative test mare cultures
• and
• Negative CF test on test mares
• Give 10 mg Lutalyse to test mares
• to abort possible pregnancy

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Test mare qualification

• 3 negative sets of sinus and fossa cultures with
  at least 3 days between cultures
• (One endometrial or deep cervical-??)
• Negative CF test for CEM
• Okay to breed a test mare back on test results
  from recently released stallion
• We vaccinate test mares for EVA
• Negative coggins test (EIA)

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Synchronization of test maresNo official
guidelines

• We use 10 mg of Lutalyse and 5 mg
• Estradiol benzoate 17ß (BET Labs) 5 days
• prior to proposed breeding
• Then 3.3 mg estradiol benzoate 17ß daily
• until breeding
• Does not guarantee mare will be in heat
• We occasionally tranquilize with10 mg
  Detomidine and
• 10 mg Torbugesic IV if mare not in heat
  - Warning
• can be dangerous

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Synchronization of test mares

• Other quarantine facilities would wait until
  mares are in heat (Safety)
• Okay to breed two mares on different days
• Okay to use ovariectomized mares

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Positive import mares procedures

• Same as described previously for mares after 3rd
  culture
• Flush beans (Cerumene) sinuses (4
  Chlorhexidine) d 1 and scrub area for 5 d
• Pack sinus and fossa area with .2 Nitrofurazone
  ointment for 5 days
• Wait 21 days after last treatments
• Repeat initial culture protocol and procedures

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Positive stallions on initial culture or after
breeding test mares

• Positive Either initial culture, culture in
  test mares or positive CF in test mares
• Same procedures as described for stallions after
  breeding
• Scrub with 4 Chlorhexidine and pack with .2
  Nitrofurazone for 5 days
• Wait 21 days after last treatment
• Repeat initial culture protocol and procedures

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Positive test mares

• Positive culture or CF test in test mares
• Same as previously described for import mares
  after 3rd culture
• Flush beans (Cerumene) sinuses (4
  Chlorhexidine) d 1 and scrub area 5 d
• Pack area with .2 Nitrofurazone for 5 days
• Wait at least 21 days
• Repeat qualification protocols
• Proposed Identify and dont reuse positive test
  mares

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Positive test mares - discharge
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My treatment protocols Positive import mares
and test mares

• Sulfamethoxazole Trimethoprim (TMS) Systemic
  (30mg/kg PO) 5 days
• 1500 mg Gentamicin 20 cc 8.4 Sodium
  Bicarbonate 25 cc saline IU for 3 days
• Flush beans (Cerumene) sinuses (4
  Chlorhexidine) day 1
• Scrub area for 2-5 days 4 Chlorhexidine
• Pack area with 1 Silver Sulfadiazine 5 days

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My treatment protocols Positive import mares
and test mares continued..

• Wait 21 days
• Repeat initial protocols include intra-uterine
  in one set of the 3 cultures
• (Okay to take more cultures on test mares)
• Test mares negative CF

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Positive import stallion on initial culture or
after test breeding

• TMS 30mg/kg PO for 7 days
• Scrub penis for 10 days with 4 Chlorhexidine
  scrub
• Pack penis for 10 days with 1 Silver
  Sulfadiazine Cream
• Wait 21 days before culturing
• Culture at 21, 28 and 35 days after treatment
• Breed two test mares and follow previously stated
  protocols starting over

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Reporting

• Positive cultures and CF test
• Notify AVIC, State CEM coordinator, farm

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Record Keeping

• No official requirements for on farm records at
  quarantine facilities
• VS has no readily available summary statistics
  for stallions and mares tested for CEM, country
  of origin, number positive etc.

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Proposed identify required information that
should be maintained by everyone

• ID of horse
• Importer
• Country of origin
• Dates of quarantine steps
• Results
• Release date
• Final destination

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Proposed record keeping

• Determine required paper work to document every
  procedure for imported equine entering approved
  CEM facility
• Save paper work from CEM quarantine facility in
  accordance with USDA records retention policy and
  make available to CEM state coordinators as
  needed

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Proposed record keeping

• Enter data at import center
• Enter data at quarantine facilities
• Enter data at state level
• Make data accessible for analysis by state,
  regional, national CEM coordinator, and managers

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Our incidence data since 1998

• 9 positive stallions and 1 positive mare
• 1.9 stallions positive (9/473 stallions)
• .07 mares positive (1/1484 mares)

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Our country of origin data since 1998 for
positive stallions

• 3 Germany (34 horses from Germany)
• 1 Holland
• 1 UK
• 1 Denmark
• 2 Austria
• 1 - Slovenia

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Our positives by breed since 1998

• 4 Warmbloods 1.3 (64 of breeds)
• 1 Friesian 3.33
• 3 Lipizzaner 37.5
• 1 Dutch Driving 16.7

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Our import mare farm records

• One warmblood mare from Germany
• (1/1484)

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Our positive stallion farm records

• 9 positive stallions
• 4 detected on initial culture
• 1 on day 10 instead of day 7
• 5 detected by test mares
• 2 in just 1 test mare (1 just CF test)
• 3 in both test mares (culture and CF)
• 1st culture and 15 day CF
• Always picked up on 15 day CF

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Future Improve stallion diagnostics

• Improved diagnostics PCR
• versus more cultures per stallion before initial
  breeding
• Research efficacy of treatment and clearance of
  carrier state
• List of approved topical or systemic treatments
  (ointments and antimicrobials)

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Movies

• A mare in heat
• Breeding a test mare
• Flushing beans and sinuses - mare
• Scrubbing and packing mare
• Scrubbing a stallion