A. vasorum Inside features... Ian Wright on A. vasorum and in house testing protocols for quick diagnosis
Change in climate creates the perfect breeding ground for slugs and snails Case studies with x-ray imagery highlight valuable learnings
T H E O N LY P R O D U C T T O T R E A T A N D P R E V E N T A.V A S O R U M
T H E O N LY P R O D U C T T O T R E A T A N D P R E V E N T A. V A S O R U M
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Angiostrongylus vasorum is on the increase Foreword by Ian Wright
A
s a vet, parasitologist and member of the European Scientific Council of Companion Animal Parasites (ESCCAP UK) I am delighted that awareness of Angiostrongylus vasorum has increased among both the public and veterinary surgeons in recent years. Although other species of lungworm are endemic in UK canids (Filaroides osleri, Capillaria aerophila and Crenosoma vulpis) it is A. vasorum which is the most pathogenic and is a parasite on the move!
After completing a Masters degree in Veterinary Parasitology at the Liverpool School of Tropical Medicine in 1997, Ian went on to qualify as a Veterinary Surgeon from Glasgow in 2002. Since then, Ian has continued research in parasitology while practising companion animal medicine and has been published in several peer reviewed journals. Ian also gives lectures to vets and vet nurses on a variety of parasite related topics and is a member of the European Scientific Council of Companion Animal Parasites (ESCCAP UK)
snail numbers combined with increased pet movement and urbanisation of foxes are all likely to have played a significant part. These factors make A. vasorum a year round rather than seasonal threat.
Many members of the public are confused about what lungworm infection means, how it might be acquired and how to prevent it, and we as vets are uniquely placed to help the public prevent this potentially life threatening disease in their pets. Vets who practise in Foxes act as a natural A. vasorum “hot spots” are “...there has been reservoir of A. vasorum well versed in advising the a spread of the public and are aware of with dogs becoming parasite across infected from slugs, A. vasorum as a differential snails and frogs acting the UK with cases for cardio pulmonary as intermediate hosts. now regularly being disease and coagulopathies This wildlife reservoir but increasingly this will reported as far tends to lead towards need to be the case for vets high concentrations of north as Scotland.” up and down the country. cases in dogs within Real time PCR and indirect specific geographic areas or ‘hot spots’ ELISA blood testing are currently being but in recent years there has been a developed for A. vasorum diagnosis but spread of the parasite across the UK with for now the gold standard remains faecal cases now regularly being reported as far examination by the Baermann or FLOTAC north as Scotland. It was initially thought method for three consecutive days. While this may be due to increased reporting important, this is time consuming to the rather than genuine spread but this client and costly so recognition of clinical pattern in the UK has been mirrored in signs and knowledge of preventative many other countries and would appear measures remains paramount. to represent a true emergence of disease. We all need to remain Lungworm aware! Although the cause of this spread is not known for certain, increasing slug and
Indications to perform the Baermann test • Clinical signs related to respiratory tract eg. cough, exercise intolerance, dyspnoea etc. • Bleeding problems of unknown origin eg. bruising, prolonged wound haemorrhage, epistaxis etc. • “Rule out” in the diagnostic work-up of other cases eg. neurological cases (CNS migration or brain haemorrhage caused by A. vasorum) with no other obvious cause (disc prolapse, tumour etc.) • Routine screening in areas known to be endemic for Angiostrongylus vasorum (NB some dogs show no clinical signs) • NOTE: All ages can be affected but young dogs <18 months of age are over-represented; accounting for ~50% of diagnosed cases (Koch & Willesen 2007)†.
To download the above guide (PDF) please visit www.jungleforvets.co.uk/lungworm2013
† Koch and Willesen 2007, The Veterinary Journal, doi:10.1016/j.tvjl.2007.11.014
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The ‘slimewave’ is upon us Gastropod explosion linked to wet weather
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t’s a fact: Gastropoda or gastropods, more commonly known as slugs and snails, are on the increase in British gardens, woodland and parks. Record rainfall over the summer and autumn has been blamed, with the soggy damp conditions providing an ideal breeding ground according to experts in the horticultural world.
Guy Barter, chief adviser at the Royal Horticultural Society, reports: “Slugs and snails have been a huge problem in 2012. I cannot remember anything on this scale. The mild winter meant that more eggs survived than usual, which only added to the excellent breeding environment created by the wet spring and summer. Unless winters are very
cold, more eggs will survive into the following spring which could further exacerbate the problem.”
of these are either too small to be seen or underground.”
Slugs are especially resilient, capable of surviving harsh environments and breeding rapidly when conditions suit. But it’s not just the green-fingered professionals who need worry.
Dogs are naturally inquisitive and are all too often keen to test new things out with their mouths, with 59 per cent of UK dog owners admitting their pet regularly eats something it shouldn’t have in the garden.3 A further 12 per cent said they have physically seen their pet eat a snail or a slug. However, it’s important to remember that dogs may ingest these away from their owners gaze either accidentally while chewing grass for example, or on purpose.
It is known that the A. vasorum parasite is spreading1 and one theory for this spread is that global warming might encourage slugs and snails to remain active for longer during the autumn and winter months, provided there is adequate moisture. In the right conditions, slugs and snails can continue to lay eggs throughout the year. It has been reported that a typical British garden could host up to 20,000 slugs and snails at any one time.2 What’s more, many people don’t realise that less than five per cent of the total slug and snail population is actually visible. Guy Barter further explains: “Moderate-sized gardens will have thousands of slugs and snails, but most
Therefore the message is clear. The only way that owners can be certain their pet is protected from A. vasorum, is by ensuring a regular preventative treatment is used.
The latest research conducted by the Royal Veterinary College has confirmed that the A. vasorum parasite is spreading beyond traditional hyperendemic foci seen in the UK, and cases have now been confirmed in northern England and Scotland1 Jenny Helm is a European Specialist in Small Animal Internal Medicine and has a keen interest in monitoring the spread of Angiostrongylus vasorum in Scotland, and commented:
“Although I do not know the exact prevalence of Angiostrongylus in Scotland, I do know that several positive dogs have been confirmed at the Small Animal Hospital in Glasgow. I also know, from recent research (publication pending), that slugs in the central belt area have been found to be positive intermediate hosts. Although many factors will influence the level of disease in dogs, in the light of these findings, my advice would be to educate owners and veterinarians about the risks of Angiostrongylus and where possible to take preventative measures given the potentially serious nature of this disease.” Jenny Helm BVMS Cert SAM Dip-ECVIM CA MRCVS
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AV Case Studies: Valuable lessons learned David Sewell MRCVS BVM&S BSc CertVC In recent years we have seen many coughing dogs that have been initially refractory to antibiotic medication yet have improved after initiating lungworm therapy. These potential lungworm cases are not uncommon. Anecdotal reports of similar experiences in other local practices are consistent with studies identifying significant Angiostrongylus vasorum infection in the southern region slug and snail population. Below are recent case studies with valuable learnings for all vet professionals:
CASE ONE
CASE TWO
The first case was a young healthy Whippet with acute onset coughing and was initially treated as an infectious tracheitis. The cough worsened inspite of antibiotic therapy and heamoptysis (coughing blood) developed so further investigation was performed. Chest radiographs and bronchoscopy were consistent with pulmonary haemorrhage. Bronchioalveolar lavage (BAL) did not show lungworm larvae but the case was consistent with a potential lungworm infection.
The second case was a Staffordshire Bull Terrier who came for a second opinion regarding chronic weight loss over a 2 month period. Their previous vet had suspected heart failure and started treatment for congestive heart failure but, in spite of this, the dog had progressively lost condition and presented in very poor body condition.
The dog slowly improved over a 4 week period on lungworm treatment and the cough has not recurred. The diagnosis was never confirmed definitively but the history, symptoms and investigation findings were otherwise typical for the condition.
Learning Young dogs presenting with coughing (with or without blood) could have lungworm; radiographs, bronchoscopy and faecal analysis are helpful in confirming the diagnosis however the absence of larvae does not exclude the diagnosis. The use of lungworm therapy is justified for any coughing dog.
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The dog was not coughing although the owner did recall a period of coughing before the dog began losing weight. Chest radiographs revealed a lung pattern consistent with pulmonary haemorrhage and bronchoscopy was recommended and performed. Pulmonary haemorrhage was present in the airways even though the dog was not coughing or bringing up blood. BAL revealed lots of Angiostrongylus larvae and faecal analysis was also positive. Treatment with anthelmintics resulted in a complete resolution of radiographic findings and weight loss. The dog returned to normal and the owner was really happy.
Learning Lungworm is real! A definitive diagnosis can be made with appropriate diagnostic tests. The examination of a faecal sample is a very simple test for diagnosing lungworm but a negative result DOES NOT RULE IT OUT. Dogs can become seriously ill from lungworm and it doesnâ&#x20AC;&#x2122;t always present with a typical cough. In this case an owner left their practice and this would have been avoided if the vets had included lungworm therapy in their approach to the case or as part of routine preventative healthcare.
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About... David Sewell
CASE THREE The third case was a Jack Russell Terrier with acute onset cough and heamoptysis that was refractory to antibiotics. X-rays and bronchoscopy were consistent with our previous two cases and although the lungwash didn’t have larvae present the faecal analysis was definitely positive for Angiostrongylus. This dog therefore had a confirmed lungworm infection however signs did not resolve with anthelminthics and further investigation which included fine needle aspirates of the lung tissue revealed neoplastic cells and a diagnosis of neoplastic lung disease was made.
Learning Lungworm is real and not uncommon. A diagnosis of lungworm does not exclude other concurrent lung conditions. We have therefore seen confirmed cases of Angiostrongylus vasorum in our clinic and they have been associated with severe clinical signs. We recommend regular lungworm prevention to all dog owners and we would typically treat any coughing dog with lungworm treatment, especially if it is refractory to initial therapy.
“I achieved my RCVS certificate in veterinary cardiology last year and therefore I see most of the cardiorespiratory cases in our practice. We aim for a high standard of clinical practice and quality of care and perform a large number of diagnostic investigations. I am open to hearing from other vets who would like to discuss lungworm or related issues.” Welcomes referral* of cardiorespiratory cases at: Heathside Veterinary Surgery 178 Locks Road, Locks Heath Southampton, Hampshire SO31 6LE Website: www.heathsidevets.co.uk David Sewell MRCVS BVM&S BSc CertVC Phone: 01489 607001 Email: bigvetdave@hotmail.com * Referral of cases to a specialist is recommended but in those cases when a specialist is too far away or exceeds the clients budget, referral to a certificate holder is a useful alternative. Feel free to contact the practice for further information or advice regarding the services offered.
Angiostrongylus vasorum L1 larvae in BAL samples from Case Two.
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More dog owners need to know about lungworm In 2009 52% of dog owners had never heard of lungworm and now in 2012, with your help, that figure has dropped to just 36%
however… Over a third of dog owners still do not know how dogs can become infected with lungworm, and 84% still don’t know the signs and symptoms of a lungworm infection in dogs.
Over the last 3 years, Bayer has been committed to educating dog owners about this fatal parasite, and this year will be no different. However 35% of pet owners said they would treat their dog regularly for lungworm if their vet were to recommend it, which is why we need you to back the Be Lungworm Aware campaign.
Opinion Matters, January 2012
The latest research conducted by the Royal Veterinary College has confirmed that the A. vasorum parasite is spreading beyond traditional hyperendemic foci seen in the UK, and cases have now been confirmed in northern England and Scotland1 Contributory factors for these findings are thought to be: • The increase in fox numbers over the last 40 years • The increased movement of dogs in and out of hot spots • The improved detection methods • Greater awareness (vets and public)
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Broad spectrum parasite protection with Advocate速 The only product licensed to treat and prevent Angiostrongylus vasorum. Prevention from the first dose. Parasite protection chart for dogs Ectoparasites
Endoparasites
Fleas
Roundworm
Hookworm
Flea larvae
Whipworm
Ear Mites
Biting Lice
Heartworm
USE MONTHLY
(D. immitis)
Fox Lungworm
Demodex
(C. vulpis)
Sarcoptes
Lungworm (A. vasorum)
Ticks and Tapeworm an issue? Advocate速 can be effectively combined with a range of Bayer products, visit jungleforvets.co.uk
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Treatment and prevention — from the first dose Prevention Study Insight
% Efficacy against L4 and immature adult A. vasorum
100
100% 80
• Infection with 200 L3 larvae per dog • Three study groups: Advocate treatment 4 days post-infection, Advocate treatment 32 days post-infection, and untreated control
60
40
• No L1 larvae and no adult parasites were found in Advocate treated dogs
20
0
Source: Schnyder M, Fahrion A, Ossent P, et al. Larvicidal effect of imidacloprid/ moxidectin spot-on solution in dogs experimentally inoculated with Angiostrongylus vasorum.Vet Parasitol. 2009;166:326-332.
• All dogs in the control group excreted L1 larvae and had a mean count of 99 adult parasites
Monthly use of Advocate prevents Angiostrongylosis through killing the L4 and immature adult stages of Angiostrongylus vasorum
“The continued expansion of the range of Angiostrongylus vasorum will put increasing populations of dogs at risk” Dr Eric Morgan MA(Cantab), VetMB(Cantab), PhD(Warw), BA, MRCVS Morgan, E. et al (2009) Canine pulmonary angiostrongylosis: The influence of climate on parasite distribution. Parasitology International 58 pp 406–410
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Study Insight
Treatment
D ogs with pre-existing patent infections: • 85.2% of dogs treated with Advocate were clear of A. vasorum after a single application
100
% Efficacy against adult A. vasorum
100% 80
85.2%
• 100% of dogs treated with Advocate were clear of A. vasorum after two applications
60
40
20
0 single treatment
second treatment
Source: Willesen J, Kristensen A, Jensen A, et al. Efficacy and safety of imidacloprid/moxidectin spot-on solution and fenbendazole in the treatment of dogs naturally infected with Angiostrongylus vasorum (Baillet, 1866). Vet Parasitol. 2007;147:258-264.
• With Advocate, there is no need to deviate from the standard treatment interval of this monthly spot-on against fleas, worms and mites Other recommendations
• Continue monthly use of Advocate to prevent Angiostrongylosis
• Examine any dogs sharing the same environment, as they may also have been exposed to infected intermediate hosts
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T H E O N LY P R O D U C T T O T R E A T A N D P R E V E N T A.V A S O R U M
T H E O N LY P R O D U C T T O T R E A T A N D P R E V E N T A.V A S O R U M
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No dogs need die of lungworm 35% of pet owners said they would treat their dog regularly for lungworm if their vet recommended it, which is why we need you to back the campaign. We will be running the TV advert again in 2013 and we have doubled the amount of coverage.
Materials can be ordered now, but will not be despatched until February 2013. All items are subject to availability.
2
1 4
3
5
Illustration purposes only Design, sizes and specifications of all items may change at end production. All items available only while stocks last.
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Prepare your practice and order your materials today. Call 0845 2574798 (or order items from the Bayer Leaflet Line www.bayer-leaflet-line.co.uk)
1 Waiting room pack
Educational display Order code: ADVO139
2 Client leaflet & dispenser Informative client leaflet Order code: ADVO136
3 Waiting room poster 1 A3 dog and slug poster Order code: ADVO137
4 Waiting room poster 2
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A3 Silent assassin poster Order code: ADVO138
5 Open/closed sign Be Lungworm Aware campign “open/closed” sign Order code: ADVO119
6 Waiting room wobblers Educational wobblers
Order code: ADVO117
8
7 Ask me badges “Ask me about Lungworm” staff
campaign badges Order code: ADVO116
8 Waiting room DVD Educational presentation Order code: ADVO121
9 Window stickers
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Vet practice window sticker Order code: ADVO118
Additional collateral and downloads available on jungleforvets.co.uk PLUS updated educational website www.lungworm.co.uk
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Advocate Spot-on Solution for Dogs Active substances: Advocate for Dogs contains 100 mg/ml imidacloprid and 25 mg/ml moxidectin. Indications for use, specifying the target species For dogs suffering from, or at risk from, mixed parasitic infections: For the treatment and prevention of flea infestation (Ctenocephalides felis), treatment of biting lice (Trichodectes canis), treatment of ear mite infestation (Otodectes cynotis), sarcoptic mange (caused by Sarcoptes scabiei var. canis), demodicosis (caused by Demodex canis), prevention of heartworm disease (L3 and L4 larvae of Dirofilaria immitis) and angiostrongylosis (L4 larvae and immature adults of Angiostrongylus vasorum), treatment of Angiostrongylus vasorum and Crenosoma vulpis and treatment of infections with gastrointestinal nematodes (L4 larvae, immature adults and adults of Toxocara canis, Ancylostoma caninum and Uncinaria stenocephala, adults of Toxascaris leonina and Trichuris vulpis). The product can be used as part of a treatment strategy for flea allergy dermatitis (FAD). Amounts to be administered and administration route Dosage schedule: The recommended minimum doses are 10 mg/kg bodyweight imidacloprid and 2.5 mg/kg bodyweight moxidectin, equivalent to 0.1 ml/kg bodyweight Advocate for Dogs.The treatment schedule should be based on the local epidemiological situation. Use During Pregnancy and Lactation The safety of the veterinary medicinal product has not been established during pregnancy and lactation. Laboratory studies with either imidacloprid or moxidectin in rats and rabbits have not produced any evidence of teratogenic, foetotoxic or maternotoxic effects. Use only according to the risk-benefit assessment by the responsible veterinarian. Contra-indications, warnings, etc: Do not use in puppies under 7 weeks of age. Treatment of dogs weighing less than 1 kg should be based on a risk-benefit assessment. Do not use in the case of hypersensitivity to the active substances or to any of the excipients. There is limited experience on the use of the product in sick and debilitated animals, thus the product should only be used based on a risk-benefit assessment for these animals. For dogs, the corresponding “Advocate for Dog” product, which contains 100 mg/ml imidacloprid and 25 mg/ml moxidectin, must be used. The product tastes bitter. Salivation may occasionally occur if the animal licks the application site immediately after treatment. This is not a sign of intoxication and disappears within some minutes without treatment. Correct application will minimize licking of the application site. In case of accidental oral uptake, symptomatic treatment should be administered. There is no known specific antidote. The use of activated charcoal may be beneficial. After accidental oral ingestion (i.e. licking at the site of application), transient neurological signs such as ataxia, generalised tremors, ocular signs (dilated pupils, little pupillary reflex, nystagmus), abnormal respiration, salivation and vomiting may be observed infrequently. The use of the product may result in transient pruritus in the animal. On rare occasions greasy fur, erythema and vomiting can occur. These signs disappear without further treatment. The product may, in rare cases cause local hypersensitivity reactions. The product may in very rare cases cause at the application site a sensation resulting in transient behavioural changes such as lethargy, agitation, and inappetence. Care should be taken that the contents of the pipette or the applied dose does not come into contact with the eyes or mouth of the recipient and/or other animals. Do not allow recently treated animals to groom each other. When the product is applied in 3 to 4 separate spots in larger dogs, specific care should be taken to prevent the animal licking the application sites. Oral uptake by Collies, Old English Sheepdogs and related breeds or crossbreeds should be prevented. During treatment with Advocate no other antiparasitic macrocyclic lactone should be administered. This product contains moxidectin (a macrocyclic lactone), therefore special care should be taken with Collies, Old English Sheepdogs and related breeds or crossbreeds, to correctly administer the product as described above. In particular, oral uptake by the recipient and/or other animals in close contact should be prevented. Ivermectin-sensitive Collie dogs tolerated up to 5 times the recommended dose repeated at monthly intervals without any adverse effects, but the safety of application at weekly intervals has not been investigated in ivermectin-sensitive Collie
dogs. When 40% of the unit dose was given orally, severe neurological signs were observed. Oral administration of 10% of the recommended dose produced no adverse effects.Up to 10 times the recommended dose was tolerated in adult dogs with no evidence of adverse effects or undesirable clinical signs. Five times the recommended minimum dose applied at weekly intervals for 17 weeks was investigated in dogs aged over 6 months and tolerated with no evidence of adverse effects or undesirable clinical signs. Up to 10 times the recommended dose was tolerated in cats with no evidence of adverse effects or undesirable clinical signs. The product was administered to kittens and puppies at up to 5 times the recommended dose, every 2 weeks for 6 treatments, and there were no serious safety concerns. Transient mydriasis, salivation, vomiting and transient rapid respiration were observed. The product was administered to ferrets at 5 times the recommended dose, every 2 weeks for 4 treatments, and there was no evidence of adverse effects or undesirable clinical signs. It is recommended that cats and ferrets living in, or travelling to areas endemic for heartworm are treated monthly with the product to protect them from heartworm disease. Whilst the accuracy of diagnosis of heartworm infection is limited, it is recommended that attempts be made to check the heartworm status of any cat and ferret aged over 6 months, before beginning prophylactic treatment, as use of the product on cats or ferrets which have adult heartworms may cause serious adverse effects, including death. If adult heartworm infection is diagnosed, the infection should be treated in accordance with current scientific knowledge. Although the product may be safely administered to dogs infected with adult heartworms, it has no therapeutic effect against adult Dirofilaria immitis. It is therefore recommended that all dogs 6 months of age or more, living in areas endemic for heartworm, should be tested for existing adult heartworm infection before being treated with the product. Dogs infected with adult heartworms tolerated up to 5 times the recommended dose, every 2 weeks for 3 treatments, without any adverse effects. No interactions between Advocate and routinely used veterinary medicinal products or medical or surgical procedures have been observed. Brief contact of the animal with water on one or two occasions between monthly treatments is unlikely to significantly reduce the efficacy of the product. However, frequent shampooing or immersion of the animal in water after treatment may reduce the efficacy of the product. Parasite resistance to any particular class of anthelmintic may develop following frequent, repeated use of an anthelmintic of that class. The solvent in Advocate may stain or damage certain materials including leather, fabrics, plastics and finished surfaces. Allow the application site to dry before permitting contact with such materials. User Safety Avoid contact with skin, eyes or mouth. Do not eat, drink or smoke during application. Wash hands thoroughly after use. In case of accidental spillage onto skin, wash off immediately with soap and water. After application do not stroke or groom animals until the application site is dry. People with a known hypersensitivity to either benzyl alcohol, imidacloprid or moxidectin should administer the product with caution. In very rare cases the product may cause skin sensitisation or transient skin reactions (for example allergy, irritation or tingling). If the product accidentally gets into eyes, they should be thoroughly flushed with water. If skin or eye symptoms persist, or the product is accidentally swallowed, seek medical attention and show the package insert to the physician. Environmental Safety Advocate should not be allowed to enter surface waters as it has harmful effects on aquatic organisms: moxidectin is highly toxic to aquatic organisms. Dogs should not be allowed to swim in surface waters for 4 days after treatment. Any unused product or waste materials derived from such veterinary medicinal products should be disposed of in accordance with local requirements. Special precautions for storage: Do not store above 30°C. Withdrawal period(s): Not applicable. Legal category: POM-V (UK); POM (Ireland).
Use Medicines Responsibly (www.noah.co.uk/responsible) FSC Logo (replace this container)
Please refer to appropriate data sheet, further information is available on request. ® Registered Trade Mark of Bayer AG. Bayer plc, Animal Health Division, Bayer House, Strawberry Hill, Newbury RG14 1JA. Tel: 01635 563000. Bayer Ltd., Animal Health * Division, The Atrium, Blackthorn Road, Dublin 18, Tel: (01) 299 9313. 1ANGIOSTRONGYLUS VASORUM IN THE UK – A NATIONWIDE POSTAL QUESTIONNAIRE SURVEY Lauren Ashley, Georgina Limon, Javier Guitian, Carlos Hermosilla & Mark Fox Royal Veterinary College, University of London, UK. 2As reported in The Independent, 15 July 2012. 3Opinion Matters survey of 1,000 dog owners, January 2012. ADVO/142/1112/ZONE/4000
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