256
11
Canine Distemper Virus
Sandra Newbury
Shelter Medicine Program, Department of Medical Sciences, University of Wisconsin-Madison School of Veterinary Medicine, Madison, WI, USA
11.1 ­Introduction
Canine distemper virus (CDV) causes a highly
contagious infection in dogs that was once
­considered the most common and deadly
­infectious disease in dogs. Though largely pre-
ventable through immunization, CDV remains
a significant cause of morbidity and mortality
in shelters because many dogs and puppies are
susceptible at the time of shelter intake and dis-
ease is often unrecognized when introduced.
While the disease is less common in owned
pets, communities with low rates of vaccina-
tion may similarly see disease more frequently.
Shelters in communities where the disease is
more common are more likely to be affected.
Infection can be inapparent, mild, severe, or
fatal in some cases. CDV may cause obvious,
acute outbreaks with high morbidity and mor-
tality or, perhaps most confusing, CDV in shel-
ters can smolder at low levels, going
unrecognized for long periods of time. In recent
years, great strides have been made in prevent-
ing illness and managing outbreaks without
resorting to depopulation. If shelters are experi-
encing problems with CDV related illnesses,
life-saving solutions can often be found.
Infectious Disease Management in Animal Shelters, Second Edition.
Edited by Lila Miller, Stephanie Janeczko, and Kate F. Hurley.
© 2021 John Wiley & Sons, Inc. Published 2021 by John Wiley & Sons, Inc.
11.2 ­Agent and Epidemiology
CDV is an enveloped ribonucleic acid (RNA)
virus in the genus Morbillivirus in the family
Paramyxoviridae. The other viruses in the
same genus include the closely related measles
virus of primates, rinderpest of ruminants and
pigs, and the peste des petits ruminants virus
found in certain small ruminants. Animals
susceptible to CDV that are most likely to be
present in shelters or have contact with shelter
animals are dogs, ferrets, coyotes, skunks, and
raccoons. Many other species are also suscepti-
ble to infection; however, zoonotic transmis-
sion (to humans) of CDV has not been
demonstrated. While dogs are the primary host
for CDV, and dog-to-dog transmission is the
most likely source of infection, it is likely that
the raccoon population acts as a substantial
reservoir and is responsible for much of the
exposure and maintenance of CDV in some
communities. A significant source of infection
in at least one major CDV outbreak in shelter
dogs was found to be infected raccoons. The
exposure apparently occurred when both spe-
cies were placed in the same animal control
vehicles (Hurley 2005).

Confusion about cats sometimes occurs
because feline panleukopenia virus infection is
sometimes referred to as “feline distemper.”
Panleukopenia or “Feline distemper” is actu-
ally caused by feline parvovirus (FPV) which is
the ancestral virus of canine parvovirus type 2.
CDV does not infect domestic cats nor cause
disease in that species, however, it does cause
disease in large felids (e.g. lions, tigers) (Ikeda
et al. 2001; Spencer 1995).
11.2.1 Biotypes of CDV
There are a variety of biotypes of CDV. The
b­iotypes have different incubation periods as
well as different disease patterns in the animal.
The classic, acute biotype of CDV that was origi-
nally isolated and characterized is often referred
to as the “Snyder Hill” strain of virus because it
was isolated and characterized at the Veterinary
Virus Research Institute (now the James A.
Baker Institute for Animal Health) at Cornell
University, which is located on Snyder Hill Rd.
in Ithaca, New York. Today, the acute virus bio-
type Snyder Hill has been replaced by a suba-
cute virus biotype referred to as R252. A very
similar, if not identical, virus, A75 has also been
isolated. These two isolates are of the same or
similar biotypes and probably are the more
common biotype in the field since the 1980s.
Importantly, though there are multiple bio-
types, there is only one serotype (antigenic
type) of CDV, and thus the modified-live virus
vaccines made in the late 1950s and early 1960s
remain highly effective in limiting infection
and preventing disease. Similarly, current
diagnostic testing appears to effectively detect
CDV in infected dogs. Outbreaks and disease
are seen because of gaps in vaccination rather
than because new biotypes are breaking
through effective immunization. In communi-
ties where vaccination is common, the disease
caused by CDV is rarely seen because vacci-
nated dogs are immune to infection and/or dis-
ease. Even in outbreak settings, dogs with
adequate antibodies do not develop clinical
signs or shed the virus. If this cross-protection
Canine Distemper Virus 257
were not effective, many more dogs would be
infected. CDV-induced disease remains com-
mon, or at least sporadic, in regions where vac-
cination is less common, and in environments
such as shelters where infected dogs or wildlife
may enter unrecognized and cause exposure to
unvaccinated or recently vaccinated dogs. This
has happened even in shelters in communities
where CDV is rarely seen in private practice
and, in each case, lapses in vaccination corre-
late well with the development of the disease.
CDV should be considered at least on the list of
differentials anytime unusually severe or fre-
quent respiratory disease is seen in a shelter.
11.3 ­Transmission
CDV may be shed in virtually all body secre-
tions and excretions depending on the stage of
infection. A lower cycle threshold (Ct) or higher
viral load on quantitative reverse transcription-
polymerase chain reaction (RT-PCR) suggests
the dog may be more likely to contribute to
transmission. (See the section (11.7) on diag-
nostics in this chapter for more information.)
CDV is a labile (unstable) virus. While fomite or
environmental transmission of CDV is possible,
the virus is easily killed by most disinfectants and
does not remain infectious outside the body for
more than a few hours to a few days, depending
on ambient temperature and other conditions.
Transmission probably occurs most com-
monly through direct contact between sick
dogs and susceptible dogs, making recognition
and isolation of animals with infectious res-
piratory disease especially important in shelter
settings where dogs will be housed together or
come into contact with each other. Aerosol
transmission between susceptible and actively
infected dogs also occurs via inhalation of air-
borne virus (Appel 1987). Mildly affected and
recovering animals may play an important role
in maintaining transmission cycles in shelters.
Fomite and environmental contamination are
of less importance for disease transmission than
for a hardier virus such as canine parvovirus
258 Infectious Disease Management in Animal Shelters
but, since the virus only needs to survive for
minutes on contaminated fomites, this route of
transmission may become significant in a shel-
ter environment through staff handling or if
equipment, kennels or holding pens are not
thoroughly disinfected between dogs. Fomite
transmission becomes even more likely when
the disease is not recognized or identified and
infectious dogs are housed or otherwise co-
mingled in the same area as healthy dogs.
11.4 ­Pathogenesis
Virus replication initially occurs in lymphoid
tissues when CDV first enters the body
(Appel 1987; von Messling et al. 2004). In all
likelihood, phagocytic cells transport the virus
from the respiratory tract to local lymph nodes
or other respiratory lymphatic tissues, where
CDV actively replicates in an immunologically
naïve dog. Once the virus begins to replicate in
the macrophage/monocyte and the T and B
lymphocytes, it is rapidly transported to
peripheral lymphoid tissues throughout the
body, including lymph nodes, spleen, bone
marrow, Kupffer cells of the liver, etc.
(Appel 1987).
During this early phase of the infection, the
animal becomes immunosuppressed with severe
T and B lymphocytopenia, interference with
macrophage function, as well as other immune
function impairment (Krakowka et al. 1975;
Schobesberger et al. 2005). Immunosuppression
can last for weeks, depending on the biotype of
CDV infecting the dog. This immunosuppres-
sion probably contributes to many of the signs of
disease seen in shelters as infected dogs become
vulnerable to secondary infections.
11.5 ­Risk Factors
for Infection
Evaluations of titers from dogs entering shel-
ters throughout the United States have shown
wide variation from region to region, but
approximately 50 ± 20% of dogs were antibody
negative for CDV at the time of intake, sug-
gesting that those dogs have never been vacci-
nated or naturally infected, are susceptible to
infection, and have a high probability of
becoming infected if exposed prior to or near
immunization (Lechner et al. 2010). Age
offers no specific benefit or protection from
the development of the disease; susceptible
dogs in any age group may develop severe clin-
ical signs of CDV. This contrasts with canine
parvovirus, where adult dogs tend to have at
least some age-related defense against the
development of severe clinical signs. More
obvious clinical signs as well as higher mor-
bidity and mortality may be seen in puppies
because young dogs are more likely to be
immunologically naive and, because of mater-
nal antibodies, are more difficult to effectively
immunize. Because of the possibility of mater-
nal antibody interference with vaccination,
puppies under 18–20 weeks of age must be
considered potentially susceptible, regardless
of their vaccination history. (See Chapter 9 on
Canine and Feline Vaccinations and
Immunology for more information about
maternal antibody interference.)
11.6 ­Incubation Period, Clinical
Signs and Disease Course
There is significant variation in the course of
the disease, clinical signs, and severity of ill-
ness dogs experience with CDV infections. The
time until onset of clinical signs, the duration
of infection and disease, and the severity of
disease are virus strain and host (dog) depend-
ent, as is the case for many viral infections/dis-
eases (Appel 1987; Summers et al. 1984). The
infectious dose or viral load the dog is exposed
to likely also plays a role. The incubation
period, depending on the strain of the virus
and the dog, may range from less than one week
up to six weeks post-infection. Longer incuba-
tion periods can be a reality but are much less
common. In the author’s experience, in the
 Canine Distemper Virus 259

field, clinical signs most often develop more

quickly and only rarely develop as late as
six weeks.
Importantly, the morbidity and severity of
the disease seen in shelters can be dramatically
lowered through the vaccination of dogs
immediately on or prior to intake. Vaccination
for CDV provides early partial protection from
the development of severe clinical illness and
neurologic disease (Schroeder et al. 1967;
Larson and Schultz 2006). Many dogs exposed
to CDV after vaccination on shelter intake will
develop only mild to moderate signs of illness
while still posing a significant risk of transmis-
sion. In this situation, CDV often goes unrec-
ognized until a dog who was not vaccinated or
a puppy who was not effectively immunized
develops more fulminant disease.
Clinical signs of CDV have frequently been
described as bi-phasic. The earliest sign of
infection with CDV would normally be an ini-
Figure 11.1 A young dog exhibiting squinting
tial febrile response within a few days to a
that can be a characteristic sign of distemper.
week after infection. This often goes unrecog-
nized, especially in shelter settings. The initial
febrile response often coincides with the onset
of a period of immunosuppression that can
occur as early as three days post-infection and
persist for weeks to a month or more.
The earliest recognized clinical signs of
CDV infection are usually non-specific signs
of malaise and respiratory disease, including
coughing and a mucopurulent nasal dis-
charge. Ocular involvement is fairly com-
mon, usually characterized by a mucopurulent
ocular discharge or squinting. These signs
occur early in the first to third week after
infection and can be difficult to differentiate
from more benign disease but should be rec-
ognized as potentially suggestive of CDV. See
Figures 11.1 and 11.2.
These early signs may be followed or accom-
panied by vomiting and diarrhea. Gastroi­
ntestinal (GI) signs may be associated with
tenesmus and bloody feces. Intussusception is
a risk. Dramatic body wasting can occur with
Figure 11.2 A puppy with canine distemper
or without anorexia and should be considered exhibiting marked mucopurulent nasal discharge
a key clinical sign. Dehydration and systemic and squinting.
260 Infectious Disease Management in Animal Shelters
collapse are a significant risk without timely
and proper medical support and intervention.
As a result of viral infection of the pulmonary
tissues, and opportunistic bacterial infection,
lower respiratory tract disease (e.g. pneumo-
nia) may also be seen during this later phase.
Skin disease (pustules) or a rare, measles-
like rash may be seen in a small percentage of
infected dogs. Digital and nasal hyperkeratosis
have also been well described and are most
often associated with varying levels of neuro-
logic disease. Distemper was once known as
“hardpad disease” a reference to the digital
hyperkeratosis that is less commonly seen
today.
A careful ocular exam is indicated in all
cases of suspected distemper because ocular
signs are relatively common. The most com-
mon ocular signs are crusting, mucopurulent
ocular discharge and conjunctivitis as
described above. Dogs may also be seen
squinting or blinking their lids. (See
Figures 11.1 and 11.2.) Keratoconjunctivitis
sicca (“dry eye”) may result in ulcer forma-
tion and perforation of the cornea, as first
described by Dr. Henri Carré in what may
have been one of the earliest descriptions of
distemper in 1905. Though rarely seen by the
author, other ocular signs of CDV may result
from viral effects on the optic nerve and the
retina. Lesions that develop on the retina, sec-
ondary to degeneration and necrosis, appear
as gray-pink densities. Post-infection, these
lesions can be identified as hyper-reflective
areas suggestive of previous infection with
CDV. Optic neuritis, sudden blindness and
retinal detachment can also occur but are
rarely reported.
Clinical signs of neurologic disease may
develop concurrently with other systemic signs,
in the absence of other signs or, very rarely,
develop one to three weeks or even longer after
the resolution of other systemic signs of illness.
Neurologic signs may range from only very sub-
tle twitching to severe seizure activity. Most
commonly, dogs who develop neurologic signs
will do so near the time of infection. This
neurologic disease results from the viral inva-
sion of neurologic tissue.
Neurologic signs are characterized by
s­alivation and chewing movements (petit mal,
chewing gum seizures) and seizures that may
become more frequent and severe (grand mal).
Though the development of central nervous
system (CNS) signs is a poor prognostic indica-
tor, some dogs may recover. Prognosis worsens
with increased severity of neurologic signs.
Some dogs who recover will clear their clinical
signs, while others may have neurologic signs
that persist but do not progress (e.g. persistent
myoclonus.)
11.6.1 Secondary Infections Associated
with Immunosuppression
As described above, CDV can cause a period of
immunosuppression with or without ­concurrent
typical signs of canine distemper. In ­shelters,
this immunosuppression most often leads to
clinical signs of canine infectious ­respiratory dis-
ease (CIRD). This ­disease complex is caused by a
variety of bacteria (Bordetella, Streptococci,
Pasteurella), Mycoplasma, and viruses (Canine
Adenovirus-2, Canine Parainfluenza Virus
(CPiV) and others) and is described in
Chapter 10. When present in dogs co-infected by
canine distemper, CIRD may cause severe
­clinical signs including pneumonia and death.
In shelters, respiratory disease from secondary
pathogens may appear more quickly than
actual pulmonary infection with CDV.
Immunosuppression may also contribute to
other opportunistic infections.
Subclinical infections are possible.
Fortunately, these subclinical infections have
not generally been of great concern in trans-
mission or outbreak management. More
importantly, clinical signs of mild CDV infec-
tions may be missed or may mimic many of the
clinical signs associated with more mild forms
of infectious respiratory disease. These mildly
affected dogs shed virus which, if unrecog-
nized, can be associated with a substantial risk
of transmission.

11.6.2 Recovery
CDV remains a potentially fatal disease and can
lead to profound illness and mortality in some
dogs. Outbreaks can cause devastating prob-
lems for shelters; resolution can require thou-
sands of dollars in resources for treatment and
diagnostic testing. But the situation for indi-
vidual dogs and shelters facing problems with
CDV has improved dramatically in recent
years. While neurologic disease still carries a
poor prognosis, this clinical manifestation is
uncommon, especially when even partial vac-
cine protection is present. In the numerous out-
breaks managed by the author and others
involving hundreds of dogs, the vast majority of
animals had uncomplicated recoveries when
treated effectively with prompt supportive care.
Mortality from outbreaks tends to be lowest in
shelters that vaccinate on intake. Once recov-
ered from clinical signs, dogs will normally be
immunocompetent and can be vaccinated and
spayed/neutered without additional precau-
tions for the individual dog. It is important to
reiterate that vaccination for CPV should not be
delayed because of CDV infection.
11.6.2.1 Viral Shedding, Carrier State
and Confirming Recovery
Viral shedding begins by one-week post-infec-
tion, sometimes before the development of
clinical signs, and usually resolves within a
short period of time following the resolution of
clinical signs. In some cases, however, viral
shedding may persist for as long as 16 weeks.
Though there is no carrier state per se for
CDV, recovered animals may remain infectious
even after the resolution of clinical signs.
Shedding is most common in respiratory secre-
tions but is possible from all tissues and bodily
excretions. Defining recovery and developing
confidence that dogs are no longer an infec-
tious risk is essential to disease control and
outbreak resolution and can be achieved
through diagnostic testing.
For defining recovery, polymerase chain
reaction (PCR) testing is probably best
Canine Distemper Virus 261
performed starting soon after the resolution of
clinical signs. A positive PCR suggests the ani-
mal may remain contagious to others, while a
negative PCR suggests the dog is less likely to
be infectious. Viral load normally drops signifi-
cantly as clinical signs resolve. (See the diag-
nostic section 11.7 for more details.)
In the author’s experience, a small fraction
of dogs may remain RT-PCR positive at low
quantitative levels for extended periods of time
(months) after recovery. It remains unclear at
the time of publication if the genetic material
being detected in these dogs represents viable
virus or a transmission concern. In the author’s
preliminary investigations, virus isolation
from swab samples collected from these “long
shedders” yielded no viable virus. (Research is
currently underway.) There is no one right
answer for how to manage the rare dogs who
remain RT-PCR positive. General recommen-
dations involve keeping the dogs away from
susceptible dogs and housing in foster or adop-
tion homes with immunized dogs.
11.7 ­Diagnosis of Canine
Distemper
Diagnostic testing can be utilized to confirm
infection and determine if recovered dogs are
still infectious. Diagnostics can also be used to
make risk assessments that identify dogs who
are likely to be protected from infection.
In the early stages of the disease, it is often dif-
ficult to recognize distemper, as the signs may
resemble CIRD (or Kennel Cough) or other dis-
eases depending on the system affected. As
described above, clinical signs of CDV encom-
pass a wide range of disease symptoms that fre-
quently overlap with other conditions commonly
seen in shelters. Oculo-nasal discharge, upper
and lower respiratory tract disease, and gastroin-
testinal (GI) disease such as inappetence, vomit-
ing, and diarrhea are the most common early
signs of disease. While neurologic disease is the
most distinctive late phase clinical sign, it is,
thankfully, seen less commonly.
262 Infectious Disease Management in Animal Shelters
Neurologic disease suggestive of CDV in any
individual animal in a shelter setting warrants
further investigation. Neurologic disease sug-
gestive of CDV in animals within the popula-
tion or after adoption, or markedly increased
severity or frequency of CIRD is cause for diag-
nostic evaluation of both the individual and the
population. In addition, diagnostic evaluation
for any dogs with signs or history suggestive of
CDV at intake will help to identify infection
and diminish the risk of transmission.
11.7.1 Diagnostic Tests
Isolation of the wildtype (virulent) virus has
always been difficult because the virulent virus
does not readily replicate in tissue culture cells,
either primary cells or cell lines. Appel found
that primary cultures of alveolar macrophages
could be used to isolate wildtype virus, but the
cells did not grow well, fresh lung tissue was
required, and the cells could not be passed
(Appel and Jones 1967; Appel et al. 1992).
Because of the difficulty of growing CDV in
tissue culture, fluorescent antibody (FA) tests
were adapted for detection of CDV in tissue
sections and in various other sources where
cells could easily be obtained (e.g. conjunctival
swab, rectal mucosa swab, leukocytes, etc.)
These assays are used on cells from conjuncti-
val, rectal, buccal, mucosal, and vaginal swabs,
tracheal washes, cerebral spinal fluid (CSF),
and buffy coats, as well as tissue biopsy
imprints or sections (Damian et al. 2005; Saito
et al. 2006). FA tests were used for years before
the development of other more reliable and
sensitive diagnostic methods.
The most commonly used diagnostic test is
now reverse transcriptase-polymerase chain
reaction (RT-PCR). RT-PCR may be used on
samples taken either from living dogs or on
postmortem tissue.
Postmortem testing may involve multiple tis-
sue samples tested by RT-PCR, FA, or immuno-
histochemistry (IHC). Also, histologic tissue
changes and the presence of viral inclusion bod-
ies in cells are diagnostic for CDV (Appel 1987).
11.7.1.1 Reverse Transcriptase-Polymerase
Chain Reaction (RT- PCR) Assay
RT-PCR assay is commonly used to detect viral
nucleic acid in samples from suspect animals.
Since CDV is shed in all body secretions/excre-
tions during the acute systemic disease, a vari-
ety of samples can be tested and would be
expected to be positive in infected dogs depend-
ing upon the phase of infection. Nasal, deep
pharyngeal, and conjunctival swabs are most
commonly collected. Conjunctival swabs tend
to yield the least amount of virus and are the
most objectionable to the dogs so are often
omitted by the author when designing a sam-
pling plan.
The sampling technique is especially impor-
tant since the sensitivity is so high. False posi-
tives are possible from sampling contamination.
Careful control of cross-contamination from
one dog or swab to the next is essential and
requires training, a glove change between each
sample collected, and diligence to ensure all
sampling instructions are followed.
It is also possible that samples tested from
recently vaccinated animals may be positive
because the modified live vaccine (MLV) CDV
replicates in most of the same cell types as the
virulent virus. Though vaccine virus replica-
tion is transient and non-pathogenic and the
virus is not shed at sufficient levels to infect in-
contact naïve animals, the sensitivity of
RT-PCR may detect the vaccine virus in certain
samples. It is not known with certainty how
long after vaccination the individual animal
would remain positive, what exact quantitative
level would be seen, or how commonly posi-
tive results occur after vaccination. It is likely
the animal would be positive as soon as three
to four days after vaccination and viral nucleic
acid could be detectable, at least in certain
samples (those with leukocytes), for up to
two weeks. The only vaccine that should not be
detected would be the canarypox vectored
recombinant CDV vaccine found in the
Recombitek ® vaccine.
Quantitative RT-PCR can help to differenti-
ate mild infections, highly infectious animals,

and vaccine positives. Positives may be reported
out as either a Ct or a viral load that is estimated
from the Ct. When a Ct is reported, a higher
number means less genetic material was pre-
sent and more cycles were run before the virus
was detected. Estimates of viral load turn the Ct
around into an estimated quantity of viral par-
ticles so the higher values indicate more virus
was present. Some laboratories will provide a
quantitative cut point above which they believe
the virus more likely results from infection
rather than from vaccination. Because recent
vaccination is so common in many shelters, it
should be verified that this information is avail-
able before selecting a laboratory to submit
samples. In general, it is expected that vaccina-
tion would only result in positives with rela-
tively low viral load or high Ct, within only
about two weeks after vaccination, and only in
dogs who were not previously immunized. It is
important to recognize that mild, early, or late
infections may also have a low viral load or
high Ct that is not related to vaccination.
Interpretation is needed to evaluate the results
in conjunction with clinical signs, dates of vac-
cination, and possible exposure for the dog.
While RT-PCR is an extremely sensitive test,
viral shedding may be intermittent, especially
in the late or recovery phase of the illness. A
single negative test result from a single sample
may not completely rule out distemper.
Because of this, repeat testing may be prudent
in some cases, especially when suspicion is
high or when attempting to define recovery.
However, in outbreak settings, the resource
investment required to obtain two negative
tests to assign risk groups or define recovery
must be carefully weighed with the additional
care days needed and additional financial
burden.
11.7.1.2 Serology
Serologic testing as a tool for diagnosis is not
particularly valuable in a shelter setting.
Serologic tests that measure IgM (early in
infection) versus IgG (later in infection) have
been used but are not reliable in the field or in
Canine Distemper Virus 263
a shelter where dogs are vaccinated at entry
(Blixenkrone-Møller et al. 1991). Paired serol-
ogy must be completed over a period of weeks.
It is expected that rising titers will be seen in
recently vaccinated dogs. More informative
tests are available for diagnosis (e.g. IHC, FA,
and PCR).
In contrast to its relatively limited value in
diagnosing disease in individual dogs in a shel-
ter setting, serologic testing is of great value in
determining the immunologic status of dogs
entering shelters or that are present at the time
of a CDV outbreak and is described in the sec-
tion on outbreak management in this chapter.
11.7.1.3 Postmortem Testing
Postmortem testing can be the most reliable
means to definitively diagnose distemper in an
individual animal and a population because
multiple tissue samples can be examined. Also,
histologic changes and the presence of viral
inclusion bodies are diagnostic.
11.7.1.4 Immunohistochemistry
and Fluorescent Antibody Tests
Immunohistochemistry (IHC), and to a lesser
extent today, immunofluorescence can be used
primarily on tissue sections after postmortem
examination for detection of CDV in situ but
RT-PCR is now more commonly performed as
part of necropsies. Because these assays are
designed to detect intact virus, with viral pro-
tein associated with the envelope antigens,
these techniques have a reduced sensitivity
and a shorter period of detection time com-
pared to RT-PCR, which detects viral RNA.
They are unlikely to detect CDV from the MLV
for more than a few days, with a peak time of
three to seven days after vaccination. This is in
contrast to the presence of nucleic acids that
are produced at higher levels and detected at
higher sensitivity with PCR. Because CDV is
widespread in tissue in infected dogs, IHC or
FA of tissue sections are sensitive methods for
postmortem diagnosis.
IHC can be performed on cells from ante-
mortem samples, including conjunctival
264 Infectious Disease Management in Animal Shelters
scrapes, urine sediment or buffy coat. These
are not believed to be affected by recent vacci-
nation so specificity is high, but due to variable
shedding in these tissues, sensitivity is low and
negative results do not rule out infection.
11.7.2 Initial Diagnostic Strategy
Recognizing disease and differentiating CDV
infection from other potential pathogens is
essential to provide appropriate treatment and
effectively control disease in a shelter setting, as
well as to identify concerns for rescue groups or
adopters. Diagnostic testing also plays a key role
in defining when an outbreak investigation or
response is necessary, assigning risk groups, and
determining when dogs are no longer a risk.
Diagnostics for an individual animal or pop-
ulation problem, such as a new arrival with
suspicious signs, a shelter with endemic levels
of disease or an outbreak of CDV, should be a
priority whenever suggestive signs are present
in an individual or within a population.
Organizations having problems with the CIRD
complex should always be wary of the possibil-
ity that CDV may be playing a role. Some addi-
tional criteria for heightened suspicion that
CDV is present in a shelter population include:
shelter and community history of problems
●●
with CDV
vaccination practices that do not ensure ALL
●●
dogs are vaccinated immediately on intake
development of neurologic disease in any
●●
dogs either in the shelter or after release
markedly increased frequency or severity of
●●
CIRD
management practices that favor transmis-
●●
sion by allowing potentially infected dogs to
remain in the general population or to have
contact with healthy susceptible animals,
especially very soon after intake and
vaccination.
Evaluating samples from multiple dogs by
PCR testing is a great beginning point for diag-
nostic inquiry if these risk factors are present.
Ideally, a mix of dogs in varying stages of clinical
illness would be sampled, including acutely
affected dogs and some that have been sick a lit-
tle longer (at least about 10 dogs or a good pro-
portion of the population that has clinical signs).
Positive results on PCR should be carefully
evaluated with consideration for both the
quantitative value, the presence of illness in
the population as a whole, and the individual
animal’s history including vaccination date,
intake date, and severity of clinical signs.
Additional diagnostics may be necessary as
part of that evaluation process. If animals have
died or are euthanized, necropsy testing of sus-
picious cases should be undertaken to permit
definitive diagnosis and rule out cofactors.
11.8 ­Treatment
Treatment recommendations for CDV focus
largely on supportive care. Detailed informa-
tion about the treatment of canine distemper
can be found in other veterinary textbooks;
only the basics will be covered in this chapter.
As mentioned earlier, systemic disease may
lead to severe dehydration and emaciation, res-
piratory disease may progress to pneumonia,
and immunosuppression facilitates invasion
by secondary pathogens. Supportive care pri-
marily revolves around intensive nursing care,
fluid replacement and systemic vascular sup-
port, nutrition, and treatment or prevention of
secondary bacterial infection. Supportive care
and treatment for secondary infections are
essential as the viral infection runs its course.
Dogs who have not developed neurologic dis-
ease have the best prognosis for recovery. The
prognosis becomes more guarded to grave for
dogs who develop severe neurologic signs
depending on severity. Mild neurologic signs,
such as myoclonus, may be more manageable,
but neurologic disease is often progressive dur-
ing the course of illness and is often irreversi-
ble. In every case where treatment is being
considered, both risk of contagion to other ani-
mals, prognosis, and welfare of the individual
animal should be considered carefully.

The judicious use of broad-spectrum
b­actericidal antibiotics is recommended when
treating respiratory disease associated with
CDV. Viral pneumonia is often accompanied
by secondary bacterial infections, or a primary
bacterial pneumonia may be present due to
CDV immunosuppression. Bacteria associated
with primary or secondary pneumonia include
Bordetella bronchiseptica, Streptococcal spe-
cies, Pasteurella multocida, Escherichia coli,
Staphylococcal species and Mycoplasma.
Secondary infections may be susceptible to dif-
ferent antibiotics than those most commonly
used in shelters to treat suspected primary
Bordetella or mycoplasma infections.
When GI signs are present, broad-spectrum
parenteral antibiotic therapy is essential. Fluid
replacement therapy in the form of polyionic
fluids such as Lactated Ringers solution cor-
rects dehydration and helps prevent systemic
collapse. B vitamins are also recommended.
Anti-emetics should be given when vomiting is
present. For dogs who are unable or unwilling
to eat, other forms of nutritional support
should be considered since treatment may be
prolonged and body wasting is common.
Treatment for the neurologic disease is com-
monly less successful than supportive care for
respiratory and systemic signs and is beyond
the scope of this chapter.
11.9 ­Prevention, Management,
and Response to Disease in
the Shelter
11.9.1 Vaccination
Vaccination of all dogs and puppies at the time
of, or prior to, intake is probably the most impor-
tant method to prevent CDV from causing dis-
ease in shelters. Modified live virus vaccines for
CDV are among the most effective vaccines
available, inducing strong, protective immunity
rapidly after administration. Even so, vaccina-
tion must be combined with planning and man-
agement strategies that focus on prevention.
Canine Distemper Virus 265
Implementing programs designed to
increase vaccination rates for dogs in the com-
munity, especially those who may not receive
regular veterinary care, would be quite helpful
in increasing overall population immunity.
Please refer to Chapter 9 on Canine and Feline
Vaccinations and Immunology for more infor-
mation on this topic.
11.9.1.1 Vaccine Types
There are two types of vaccines available as of
this writing: (i) modified live viral (MLV) CDV
vaccine; and (ii) recombinant (r)CDV vaccine.
The CDV vaccine from Boehringer Ingelheim
has a canarypox vectored recombinant CDV
component, whereas all the other products are
conventional MLV. A small study suggested
that the canarypox rCDV has the potential
advantage of providing more rapid protection
in the face of maternal antibody (Pardo
et al. 2007). However, most puppies entering
shelters do not have maternally derived anti-
body (MDA), likely because being an unsteri-
lized bitch, having a litter of puppies that ends
up in a shelter, and being unvaccinated, are
risk factors arising from similar circumstances
(Lechner et al. 2010). The MLV are generally
lower cost than recombinant vaccines and have
the theoretical advantage of being able to com-
petitively occupy viral binding sites, generating
protection even before humoral immunity is
induced. Therefore, MLV are generally pre-
ferred in shelters for puppies as well as adults.
11.9.1.2 Vaccine Efficacy and Safety
MLV CDV and rCDV vaccinations provide sig-
nificant protection even when dogs are chal-
lenged with exposure almost immediately
following vaccination. One study (Schroeder
et al. 1967) showed significant benefit from
MLV CDV vaccination of susceptible puppies
compared to those who were unvaccinated
even when puppies were placed immediately
into a CDV contaminated environment.
Recombitek™, the rCDV vaccine product by
Boehringer Ingelheim, provided protection
against IV challenge one week after vaccination,
266 Infectious Disease Management in Animal Shelters
and p­rotected dogs placed in a distemper con-
taminated environment within hours of
administration (Larson and Schultz 2006).
It is important to recognize that the very
early benefits from vaccination described in
the studies above are not likely to confer the
same sterile immunity that can be expected a
little later from vaccination for CDV. Full
immunity does develop quite quickly but may
not be reached for three to five days. Instead,
the very early post-vaccine immunity pro-
vides protection from the development of
severe neurologic disease and death. Dogs
challenged by exposure within 72 hours of
vaccination may become infected, shed virus,
and be a risk to other susceptible dogs in the
population even if they do not develop fulmi-
nant disease.
When vaccinations are administered on
intake; preventative management practices are
put in place to minimize co-mingling, expo-
sure and stress; and sick animals are promptly
isolated, the short lag between vaccination and
onset of sterile immunity does not often lead to
clinical problems. However, in environments
where susceptible and potentially infectious
dogs are housed or allowed to co-mingle
together or share common space, the disease
may still occur in dogs who are vaccinated at
intake and exposed shortly afterward. This can
create some confusion and be associated with
ongoing, endemic disease that may mimic
unusually frequent or severe CIRD.
11.9.1.3 Vaccine Handling
Because CDV is relatively labile, it is critical
that the vaccine is reconstituted only shortly
before use, taking care not to leave the vaccine
at room temperature. If the room or ambient
temperature is elevated, it is especially impor-
tant that vaccines are reconstituted just prior
to administration. The vaccine can be adminis-
tered subcutaneously or intramuscularly. If
any portion of the vaccine fails to be adminis-
tered subcutaneously (e.g. part of it is injected
onto the skin or hair coat), a second full dose
should be given immediately.
11.9.1.4 Vaccine Timing and
Revaccination
Every animal over four to five weeks of age
should be vaccinated prior to or upon arrival to
a shelter, regardless of their health status at the
time of arrival. Vaccines are unlikely to cause
harm, whereas virulent virus is likely to be pre-
sent. For animals who are sick, it is possible,
though not likely, the animal will be unable to
mount an immunizing response. It is unlikely
the vaccine will adversely affect the animal,
while there is a good chance much needed pro-
tection will be provided.
Provided maternal antibody interference is
not present, the majority of dogs over
16–20 weeks of age will be protected by a single
vaccination. However, because of the severity
of the illness, the low risk associated with the
vaccine, and the small chance of vaccine fail-
ure due to factors such as incorrect handling or
errors in administration, an initial series of
two vaccines two to three weeks apart is gener-
ally recommended (Welborn et al. 2011). Dogs
who remain in the shelter for long periods of
time need not be re-vaccinated more often
than every three years as per the American
Animal Hospital Association (AAHA) vaccina-
tion guidelines.
11.9.1.5 Vaccination of Puppies
As with other diseases, interference from MDA
can hinder effective immunization of puppies
under 20 weeks of age. While many puppies
will not have sufficient MDA to interfere and
will be effectively immunized by the initial
vaccine, it can never be certain which puppies
may not be effectively immunized. Therefore,
regular vaccination for puppies with combina-
tion vaccine products should begin at four to
six weeks of age and be repeated every two
weeks if puppies are in a high-risk environ-
ment such as a shelter or high population vol-
ume foster home, until 20 weeks of age. After
adoption or transfer to a low-risk environment,
the interval of revaccination can be extended
to three weeks, but even after adoption, pup-
pies should receive a final vaccine at or after

20 weeks of age. The rationale for giving the
final vaccine for shelter puppies at a later age
than has commonly been recommended for
purposely-bred puppies is two-fold: the possi-
bility that the dam recovered from field strain
infection leading to higher than average levels
of maternal antibodies, and the difficulty of
accurately aging puppies when the exact birth
date is unknown (as is often the case in
shelters).
Again, it should be emphasized that vaccina-
tion alone will never be a sufficient interven-
tion when disease and exposure risk is high.
Vaccination programs must work in concert
with management plans that decrease infec-
tious dose and risk of exposure, especially for
puppies who may remain susceptible even
after vaccination. The best management plan
for susceptible juvenile animals is almost
always housing outside of the shelter in an
alternate, low-risk environment.
11.9.1.6 Special Considerations
for Pregnant Dogs in a Shelter
If a pregnant animal arrives at a shelter, the
risks and benefits of vaccination must be care-
fully weighed. The safest CDV vaccine to use
in pregnant dogs is the canarypox rCDV vac-
cine, as the MLV in immunologically naïve
(CDV antibody negative) dogs has the poten-
tial to infect the fetuses, very rarely causing
death and absorption or abortion. While there
may be a small risk to the unborn puppies
from vaccinating the dam, if she has not been
previously immunized, the risk to the dam
entering a shelter environment unvaccinated
and susceptible, followed by likely to almost
certain exposure, could be very high. As a
result of an effort to protect the fetuses from
the possible adverse effects of vaccination, the
dam and the puppies could all be lost to the
disease.
Regardless of the vaccine type used (recom-
binant or MLV), pregnant dogs that have anti-
bodies will not be infected with the vaccine
virus, thus the embryos/fetuses will not be
affected. Because canine parvovirus is likely
Canine Distemper Virus 267
also a risk, a monovalent product for CPV
should also be strongly considered if the ferret
rCDV product is used.
11.9.1.7 CDV Vaccination of Other
Species
For species other than dogs (e.g. raccoons, fer-
rets), the PureVax® Ferret rCDV vaccine (1.0 ml
dose) should be used rather than a MLV vac-
cine because of the adverse reactions the MLV
vaccine may cause in these species. MLV CDV
vaccines should only be used in the species for
which they were licensed.
11.9.2 Environmental Control
Because CDV is an RNA virus that is envel-
oped, the virus is rapidly inactivated outside
the body by a variety of disinfectants, many of
which are commonly used in shelters. (See
Chapter 8 on Sanitation for more information.)
CDV is also rapidly destroyed by heat. At tem-
peratures of 56° C (130° F), it has a half-life of
four to five minutes, at 45° C (113° F), 10 min-
utes, at body temperature and room tempera-
ture, 37° C (99° F) and 21° C (68° F) respectively,
about one to three hours, and 9–11 days at 4° C
(42° F). Therefore, unlike canine parvovirus-2,
which is very stable in the environment and
resistant to many disinfectants and heat, CDV
is very labile and can be readily destroyed in
the environment.
Notwithstanding this, even the short-term
persistence of the virus in the environment can
contribute to transmission. Efforts at decon-
tamination in the face of an outbreak or persis-
tent endemic disease concerns should focus on
identifying points of common contact, espe-
cially surfaces likely to be in contact with sick
and newly admitted, susceptible animals. This
should include consideration of animal con-
trol vehicle compartments, intake pens that
are also used for housing sick animals prior to
transfer or euthanasia, and staff clothing if
biosecurity precautions are not followed
between handling sick and healthy individuals
or populations.
268 Infectious Disease Management in Animal Shelters

11.9.3 Isolation and Separation Isolating or separating sick dogs removes the
greatest source of exposure in the shelter.
As mentioned above when describing trans-
Subclinically affected dogs may still shed virus
mission, infected dogs serve as the primary res-
and go unrecognized as infectious, but this
ervoir for the virus. When infected dogs are
tends to be less clinically relevant. The reduc-
intermixed with susceptible dogs, transmis-
tion in infectious dose in the environment that
sion is very likely to occur. This makes isola-
results from isolating the dogs who are most
tion or separation of all dogs with clinical signs
obviously a potential risk has a substantial
of disease an essential component of distem-
effect on clinical disease reduction.
per prevention and control. This is especially
Separation of sub-populations of apparently
true for respiratory disease because of the
healthy dogs and puppies works hand in hand
strong potential for aerosol transmission and
with isolation to protect susceptible animals as
the frequent overlap of signs of canine respira-
they enter the shelter. In many cases, transmis-
tory disease complex and early or milder to
sion can be interrupted by establishing defined
moderate canine distemper. However, as a gen-
housing areas and order of care for specific
eral practice, dogs with any clinical signs of
susceptible groups.
potentially infectious disease (e.g. GI, neuro-
Special handling practices to reduce trans-
logic) should also be isolated from the general
mission should be targeted toward the most
population.
susceptible animals. In general, separation is
Isolation for CDV ideally is achieved by the
most important for puppies, since MDA may
use of a separate building or ward, including
cause interference with vaccination that leaves
separate airflow. Proper protective garments
many of them susceptible even post-vaccina-
should be provided as well as separate equip-
tion. Healthy puppies should be housed in
ment for use in the isolation area exclusively.
double-sided kennels that can easily be cleaned
Staff must be trained in isolation procedures
while the puppies remain protected within the
and either designated to work in that area only,
enclosure, with designated equipment for use
sequenced so that healthy animals are never
exclusively in that area and handling by staff
handled or cared for after sick animals, or full
wearing clean protective garments. Identifying
biosecurity must be utilized, including a
clinical signs and isolating or separating sick
change of coveralls, gloves, and footwear
animals promptly helps protect incoming ani-
between affected and susceptible populations.
mals during the first several days after admis-
In some cases, a separate ward is difficult to
sion when they have been vaccinated but have
establish. In that case, creating separation
not had sufficient time to develop full
where sick animals are promptly identified
immunity.
and moved, housed in a designated area sepa-
rated by at least two empty kennels from the
susceptible population, and never cared for 11.9.3.1 Planned Co-mingling
ahead of healthy animals are strategies that and All-In All-Out Housing
have been effectively implemented to bring an Group housing dogs randomly at intake
end to disease transmission. Even simple because there is insufficient housing in the
measures to create separation between healthy shelter is an enormous risk factor for the trans-
animals and those with clinical signs can have mission of many infectious diseases and creates
a dramatic effect on improving animal health. poor welfare. Shelters with this practice should
Housing and/or treating sick animals in the evaluate their intake and flow-through prac-
general population will ensure exposure of the tices as well as housing capacity to implement
entire population, and if CDV is present, it will change. If a shelter does plan to group house
lead to severe disease in at least some suscepti- recently admitted dogs, screening carefully for
ble animals. signs of illness and planning co-mingling of

apparently healthy dogs can reduce the risk of
transmission presented in group housing by
defining cohorts or subgroups within the gen-
eral population; this reduces both the viral load
and the number of animals to which each ani-
mal is exposed. To implement planned co-min-
gling, a system must be put in place defining
which incoming healthy animals will be co-
housed and interact with each other in play-
groups or other activities. The simplest method
is to identify behaviorally and physically com-
patible dogs who are entering the shelter at the
same time (e.g. the same day). Only those dogs
who are part of the planned cohort would inter-
act with each other.
Though in general, co-mingling is not rec-
ommended, when undertaken, all-in all-out
housing is an essential component of planned
co-mingling. All-in all-out housing dictates
that when co-mingling is necessary, all dogs
will be removed from the housing unit or hous-
ing area before new susceptible dogs are
brought in. Ideally, animals are moved through
the shelter in cohorts. New animals should not
be added once the group has been established.
When all-in all-out practices are not used, it is
possible that one subclinically infected animal
could remain in an area long enough to expose
another susceptible animal and so on, creating
a cycle that allows persistence of the virus in
the population. All-in all-out housing inter-
rupts that cycle by creating small groups in
which all dogs are less likely to have been
infected. Each time one group leaves, the risk
of exposure for the new group begins with just
those dogs who have entered together, with no
risk carried over from the previous group.
All-in all-out housing is an important compo-
nent of halting a cycle of transmission.
11.10 ­CDV Outbreak
Management
If an outbreak of distemper does occur in a shel-
ter, it is possible to control the outbreak and
bring the shelter back to a healthy state by using
Canine Distemper Virus 269
life-saving evaluation and response t­actics.
Once an outbreak occurs, it becomes even more
essential that all dogs are vaccinated prior to or
at entry. Response measures, beyond vaccina-
tion, must also be taken when the disease has
been identified in the general population. This
consists primarily of assigning risk categories,
creating a sanitary environment for incoming
dogs (clean break) and isolating or removing
exposed potentially infectious animals.
Please see Chapter 6 on Outbreak
Management for more information.
11.10.1 Outbreak Risk Factors
Population health management practices play
an important role in the prevention of CDV
transmission in the shelter setting. Common
risk factors in shelters experiencing outbreaks
or ongoing problems with CDV in their popu-
lations include sporadic or delayed vaccina-
tion; failure to examine or vaccinate animals
on intake; crowding beyond the capacity for
care; kennels that are used inappropriately or
in ways other than intended when designed
(e.g. guillotine doors closed in double-sided
housing units); group housing that is not all-in
all-out; lack of separation between sick and
healthy animals; poor or infrequent use of dis-
ease detection methods and lax response to
respiratory disease that is believed to be “ken-
nel cough.” Animals transferred from other
shelters may also increase the risk of CDV if
the source shelters are in CDV endemic com-
munities or have any collection of these risk
factors.
11.10.2 Risk Assessment
Through a combination of careful observation
of clinical signs and antibody testing, risk cat-
egories can be assigned to dogs. Risk categories
help management to move dogs who are not
likely to be affected by the disease through the
shelter quickly, leaving a much smaller, more
easily managed group for outbreak response or
treatment.
270 Infectious Disease Management in Animal Shelters
While assigning risk groups never provides
an absolute guarantee of whether a particular
animal will become infected or not, defining
the level of risk for individual animals and sub-
groups can at least guide informed decisions.
Risk assessment can be used to clear animals
for rescue or adoption and help guide efforts to
create effective isolation and separation.
Establishing risk categories for exposed ani-
mals limits the number of dogs subject to quar-
antine, isolation, or special rescue. Because
some animals may have strong immunity to
distemper demonstrable via serologic assess-
ment, it may not be necessary to treat all who
have been exposed as potentially infectious or
“at-risk.”
Serologic risk evaluation is a valuable tool,
especially as an alternative to quarantine for
CDV because its long incubation period, in
many cases, makes quarantine of all exposed
dogs difficult to impossible for many shelters
to implement. Antibody testing correlates
well with immunity for CDV, and both com-
mercial and in-house tests (Vaccicheck™ and
Synbiotics TiterCheck™) are available for this
purpose. Those dogs that are free of clinical
signs and have sufficient antibodies can be
considered protected and are very unlikely to
become infected or develop the disease. One
caveat is that when disease detection and mon-
itoring have not been consistently or effectively
performed, it may be necessary to pair sero-
logic testing with RT-PCR testing even in dogs
with no clinical signs to be sure clinical signs
weren’t missed and the dogs are not in the
recovery phase of illness and still shedding
virus. In the author’s experience, it is not
uncommon in complex outbreaks to find
apparently healthy dogs whose immune status
and PCR testing together suggest they were
recently infected and continue to shed some
level of the virus as the outbreak intervention
gets underway. It is important to identify and
isolate these dogs when establishing a clean
break to stop the cycle of transmission.
Using serologic testing sparingly on dogs
recovering from clinical signs who tested
positive on PCR can also save resources in an
outbreak setting. It is almost certain that dogs
who were infected will develop protective anti-
body titers, so serologic testing in these dogs
should be a low priority for resource
investment.
In-house serologic tests have great value
because they can be run fairly quickly and sim-
ply and provide immediate answers about
immunologic status. Samples for serology can
also be sent to diagnostic labs, but turnaround
time for results is important in an outbreak
response setting. When attempting to identify
low risk, clinically healthy animals for adop-
tion or transport, it is more financially frugal to
test for antibody first and pair positive anti-
body results with a PCR that suggests the dog
is not currently shedding virus. If the dog is
antibody negative or insufficient antibody is
present to suggest protection, then a PCR
should be repeated at the time the next anti-
body test was collected to suggest that the titer
was rising because of vaccination and not as
the result of infection.
Many questions arise about serology testing
in puppies. Puppies under five months of age
may have MDA present. This passive immu-
nity is detectable on most serologic tests but
can’t be well differentiated from active immu-
nity. Passive immunity does not have the
backup system of antibody-producing memory
cells that active immunity provides, which
suggests it may be somewhat less protective.
Also, maternally derived antibodies are con-
stantly degrading, so antibody levels from pas-
sive immunity are likely to drop with time,
making the puppies more at risk of infection.
Adding to this complication is the potential for
MDA interference with immunization from
vaccination. With all of this being true, clini-
cally, puppies with sufficient antibody titers
appear to be protected from infection just as
adult dogs are. The difference in terms of man-
agement is that while the immune status of
adult dogs who are antibody positive will not
change, it is probable that the immune status
of puppies changes over time. While adult

dogs who are known to be protected can
remain in an environment where the virus is
present, it is essential that puppies identified as
low-risk through antibody testing be removed
from the risk of continued exposure as quickly as
possible.
When titer testing cannot be used to assign
risk groups, dogs can be assigned to risk
groups based on vaccination dates and the
likelihood of exposure. However, this method
will mean that many will be considered high
risk unless a known start date can be identi-
fied for possible exposure or excellent man-
agement practices were in place to prevent
transmission. If complete veterinary vaccina-
tion records are available, dogs who had been
vaccinated when older than 20 weeks and
prior to admission or possible exposure should
be considered low-risk but revaccination is
likely still the safest course of action. Verbal
assertions by owners relinquishing dogs that
they are “current on their vaccinations” are
inadequate to ensure protection.
11.10.3 Quarantine Requirements
for High-Risk/Exposed Dogs
If high-risk dogs must remain in the shelter,
they should be separated from other dogs,
especially those who have been recently admit-
ted, recently vaccinated and all puppies under
20 weeks of age. In the past, it has been recom-
mended that these dogs should be held for a
quarantine period of at least four to six weeks
to ensure that they are not incubating the dis-
ease. In many cases, this long holding time is
impossible for the shelter; it also creates wel-
fare concerns or runs the risk of actually con-
tributing to more disease in the shelter due to
crowding. Quarantine areas should have safety
procedures equivalent to those described for
isolation areas above in the section on isolation
and separation. As an alternative, the develop-
ment of positive serology paired with a nega-
tive RT-PCR can provide good evidence that a
dog has developed immunity usually much
sooner than the full incubation period.
Canine Distemper Virus 271
11.10.4 Creating a “Clean Break”:
Protection of Incoming Dogs
During an Outbreak
When responding to an outbreak, all dogs,
without exception, must be vaccinated prior
to or within minutes of entry. All incoming
dogs should be placed into clean, disinfected
kennels. Housing for incoming dogs should
be located at least 25 ft away from moderate
to high-risk dogs (based on titers, exposure
history or clinical signs) and from other dogs
coming in with clinical signs of disease; ide-
ally, this should be a separate building or at
least a separate ward. If necessary, this can
be a separate set of runs with clear visual
barriers delineating at-risk versus clean
areas. As described above for isolation, sepa-
rate staff and supplies should be used for
new incoming dogs versus exposed/at-risk
dogs. Dogs designated as low-risk based on
titer testing can be housed with new incom-
ing dogs, if necessary, based on space
considerations.
When separate housing for exposed versus
new incoming dogs is not possible, a “snaking
clean break” has been used successfully to
resolve an outbreak. While not ideal, this
method can reduce risk and overall mortality.
A snaking clean break is created by establish-
ing a separation of exposed versus incoming
dogs of at least 25–40 ft (7.7–12.2 m). This can
be achieved, if necessary, by leaving several
empty kennels between exposed and incoming
dog housing areas. Clear visual markers desig-
nate each area, such as signage, rope, or chain
barriers, and full-width curtains hung across
aisleways. Designated equipment and biosecu-
rity precautions must be used for each area just
as would be the case if truly separate buildings
or wards were available. However, as the popu-
lation of exposed/at-risk dogs dwindles (e.g.
through transfer or clearance of quarantine)
and the population of newly admitted dogs
grows through ongoing intake, the location of
the clean break can be changed to accommo-
date this dynamic flow.
272 Infectious Disease Management in Animal Shelters
Initially, most of the dogs in the shelter may
be considered exposed/at-risk and just a few
kennels will be designated for new intakes,
while late in the resolution of an outbreak the
reverse will be true. Of course, thorough clean-
ing of kennels that are transitioning from
housing exposed to newly admitted dogs is
critical in this circumstance.
11.10.5 Summary of Outbreak
Control
Outbreaks within the shelter can be brought
under control with careful attention to the
measures described above. Clinical cases
may continue to occur, but they should be
limited to dogs infected before entering the
shelter. If timely preventive management
practices are put into place as part of the out-
break response, disease transmission from
these cases can be controlled and future out-
breaks avoided.
11.11 ­Considerations
for Adoption
Decision making and safety surrounding
adoptions or transfers of dogs during or after
an outbreak can be greatly aided by the use of
diagnostic testing. Diagnostic testing can help
assess if dogs continue to shed virus or are
safe to interact with other dogs. A combina-
tion of RT-PCR testing for antigen and anti-
body testing can help to clear dogs for
adoption or transfer. A negative RT-PCR test
in combination with a positive antibody test
suggests the dog is very unlikely to pose an
infectious risk.
As noted earlier, some recovered dogs may
continue to test positive on RT-PCR for pro-
longed periods. It is unknown at this time if
dogs testing positive on RT-PCR for very pro-
longed periods actually continue to be an
infectious risk, but until clarity is gained, it is
important to proceed with caution. This rare
prolonged timeframe for positive results is
possible even for dogs where clinical signs
have not been noted. In shelters that were not
vaccinating at intake, viral shedding within the
group tends to last longer.
Adopters or shelters receiving recovered or
exposed/at-risk dogs who have not been
cleared using diagnostics should be made
aware that the dog may have been exposed or
infected with CDV and advised to keep the
dog away from areas frequented by puppies,
due to disease progression or development of
infection. These concerns arising from failure
to utilize diagnostic testing to help define risk
can create significant welfare concerns for all
concerned, (i.e. the shelter, adopter and the
dog), and is also likely a false economy com-
pared with the cost of testing. In the author’s
experience, clearing dogs through diagnostic
testing to allow for adoption and transfer
without additional precautions has been a
safe and powerful life-saving tool. After man-
aging hundreds of dogs with this systematic
process, we have not had any reports of a
cleared dog going on to cause infectious prob-
lems or develop new clinical signs related to
CDV.
11.12 ­Conclusion
Canine distemper remains an important and
challenging disease, especially in animal
shelters, throughout the United States and
world. Fortunately, this potentially devastat-
ing disease is vaccine-preventable and if
effective vaccination programs are used in
shelters and, more importantly, if more dogs
in the community were properly vaccinated,
CDV could be substantially reduced as an
important cause of disease. Until that time,
meticulous examination and vaccination of
animals on intake, careful monitoring, sepa-
ration and isolation of symptomatic animals,
and prompt diagnosis and response when the
disease is suspected can greatly minimize the
damage inflicted by this once-relentless
disease.

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