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today's Veterinary Practice July/August 2014 70 | american Heartworm Society'S Heartworm Hotline tvpjournal.com bama replacing Louisiana as the state with the highest number of cases reported per clinic (Table). Heartworm incidence historically remains highest in the southeastern quadrant of the U.S. However, relatively high incidence rates were reported in areas less well known for heartworm risk, including the upper Midwest, especially Michigan, Illinois, Indiana, Ohio, Arizona, and California. Influence of Weather & Economy AHS survey administrators analyz- ing the data believe the differences between 2010 and 2013 could be at- tributable, in part, to 2009 weather patterns. The summer of 2009 was cooler in many areas of the country, and drought conditions existed in others, leading to a decrease in local mosquito populations. In addition, economic factors re- lated to the U.S. recession were be- lieved to have altered patient testing patterns. Differences Among Locales Significant variation in the rates re- ported among adjacent counties, communities, and even neighbor- ing practices was noted in 2010. It was not uncommon for a county with several practices to report 100 heartworm-positive patients, while the neighboring county practices consistently reported no cases of heartworm infection. In 2013, the data were more consistent among practices in the same counties and adjoining counties. Despite the variations in map pre- sentation, the overall incidence of heartworm in the U.S. has not mea- surably decreased because areas of high incidence had an increased number of cases than in previous years. FACTORS INFLUENCING HEARTWORM TRENDS Veterinarians who supplied heart- worm data were also asked ques- tions regarding trends in heart- worm incidence, prevention use, and treatment protocols within their practices (Figure 2). These questions accentuated the follow- ing trends. Importance of the Disease Of the veterinarians surveyed: • 18% considered heartworm in- fection a significant disease problem • 15% stated that heartworm infection was one of the most serious diseases affecting their patients • 54% reported that heartworm infection is diagnosed oc- casionally • 13% said they never see heartworm-positive patients. table. comparing 2010 & 2013 Heartworm incidence averages 2013 AHS SURVEY 2010 AHS SURVEY Rank State HW+ cases/ practice State HW+ cases/ practice 1 alabama 89.9 louisiana 104.6 2 louisiana 80.5 mississippi 80.9 3 mississippi 73.1 texas 52.5 4 texas 47.9 South carolina 37.5 5 arkansas 35.6 arkansas 37.3 6 South carolina 31.7 Georgia 36.8 7 north carolina 29.3 alabama 30.6 8 tennessee 23.5 north carolina 25.5 9 Georgia 22.9 tennessee 19.2 10 oklahoma 19.8 oklahoma 17.8 Figure 2. Veterinarians weighed in on the causes of current trends in heartworm prevalence as part of the survey. Q. in your opinion, what is the trend of heartworm prevalence in your area over the past 3 years? A. 19% of veterinarians surveyed said the trend is up, 21% said the trend is down, and 60% said it has stayed the same.