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tvpjournal.com July/August 2014 today's Veterinary Practice 71 american Heartworm Society'S Heartworm Hotline | Incidence Trends Sixty percent of veterinarians stated that the incidence of heartworm dis- ease in their practice areas had re- mained the same since the last AHS survey was conducted 3 years earlier. A roughly equal proportion of veteri- narians said that incidence was up (19%) and down (21%) in their prac- tice areas. Contributing Factors Veterinarians who witnessed an up- ward or downward trend in heart- worm disease reported on multiple factors related to those trends. The findings are as follows: 1. Poor compliance: Poor compliance by clients, defined as not admin- istering preventives year-round or skipping doses, was the most com- mon factor cited by veterinarians (61%) who witnessed an upward trend. Approximately 40% of veter- inarians in this group noted an in- flux of infected rescue dogs to lo- cal areas. 2. Increased compliance/preventive administration: An increased num- ber of pet owners administering preventives (74%) and improved compliance (63%) were the lead- ing reasons provided by veterinar- ians who noted a downward trend in heartworm incidence. 3. Weather: A mong veterinarians who saw a rise, 39% cited weath- er as a contributing factor result- ing in increased mosquito popula- tions; whereas, only 16% of those who saw a decrease attributed the change to less favorable weather conditions for mosquitoes. 4. Economy: Veterinarians who not- ed an increase in heartworm inci- dence were more likely to cite neg- ative economic factors than those who saw a decrease in incidence. Twelve percent of practices noted that improvements in the economy and a resulting increase in preven- tive usage had a positive effect. 5. Efficacy: Heartworm preventive lack of efficacy (LOE) was not con- sidered a major factor. Among the 19% of veterinarians who reported that heartworm incidence was up, less than 6% cited LOE as a possi- ble factor. THE ROLE OF RESOURCES A large majority of surveyed veter- inarians (72%) reported that they follow the AHS Guidelines for the Prevention, Diagnosis, and Man- agement of Heartworm (Dirofilar- ia immitis) Infection, available at: • Dogs: heartwormsociety.org /pdf/2014-AHS-Canine- Guidelines.pdf • Cats: heartwormsociety.org /pdf/2014-AHS-Feline-Guidelines. pdf In addition, 40% of veterinarians use the AHS website ( heartworm societ y.org ) as a resource, and another 32% use AHS client education tools, available at heartwormsociety .or g / veter i n a r y-r esou r ces/order- publications.html . IN SUMMARY Heartworm incidence rates remain high in the U.S., but the survey re- sults indicate that the power to sig- nificantly reduce disease incidence is in the hands of veterinarians and their clients. Recommendations by veterinary professionals to admin- ister heartworm preventives year- round—and client cooperation in giving these preventives on time and as directed—should be the goal. The AHS will conduct the next Heartworm Incidence Sur vey in early 2017 and base the findings on data from the 2016 calendar year. n aHS = american Heartworm Society; loe = lack of efficacy CAUTION: Federal (US) law restricts this drug to use by or on the order of a licensed veterinarian. BRIEF SUMMARY: Please consult package insert for complete product information. Indications: For use in dogs to prevent canine heartworm disease by eliminating the tissue stage of heartworm larvae (Diroflaria immitis) for a month (30 days) after infection and for the treatment and control of roundworms (Toxocara canis, Toxascaris leonina), hookworms (Ancylostoma caninum, Uncinaria stenocephala, Ancylostoma braziliense), and tapeworms (Dipylidium caninum, Taenia pisiformis). WARNINGS: For use in dogs only. Keep this and all drugs out of reach of children. In safety studies, testicular hypoplasia was observed in some dogs receiving 3 and 5 times the maximum recommended dose monthly for 6 months (see Animal Safety). In case of ingestion by humans, clients should be advised to contact a physician immediately. Physicians may contact a Poison Control Center for advice concerning cases of ingestion by humans. PRECAUTIONS: Use with caution in sick, debilitated, or underweight animals and dogs weighing less than 10 lbs (see Animal Safety). The safe use of this drug has not been evaluated in pregnant or lactating bitches. All dogs should be tested for existing heartworm infection before starting treatment with IVERHART MAX Chewable Tablets, which are not effective against adult D. immitis. Infected dogs should be treated to remove adult heartworms and microflariae before initiating a heartworm prevention program. While some microflariae may be killed by the ivermectin in IVERHART MAX Chewable Tablets at the recommended dose level, IVERHART MAX Chewable Tablets are not effective for microflariae clearance. A mild hypersensitivity- type reaction, presumably due to dead or dying microflariae and particularly involving a transient diarrhea, has been observed in clinical trials with ivermectin alone after treatment of some dogs that have circulating microflariae. ADVERSE REACTIONS: In clinical feld trials with ivermectin/ pyrantel pamoate, vomiting or diarrhea within 24 hours of dosing was rarely observed (1.1% of administered doses). The following adverse reactions have been reported following the use of ivermectin: depression/lethargy, vomiting, anorexia, diarrhea, mydriasis, ataxia, staggering, convulsions and hypersalivation. ANIMAL SAFETY: Studies with ivermectin indicate that certain dogs of the Collie breed are more sensitive to the effects of ivermectin administered at elevated dose levels (more than 16 times the target use level of 6 mcg/kg) than dogs of other breeds. At elevated doses, sensitive dogs showed adverse reactions which included mydriasis, depression, ataxia, tremors, drooling, paresis, recumbency, excitability, stupor, coma and death. No signs of toxicity were seen at 10 times the recommended dose (27.2 mcg/lb) in sensitive Collies. Results of these studies and bioequivalence studies support the safety of ivermectin products in dogs, including Collies, when used as recommended by the label. In a laboratory safety study, 12-week-old Beagle puppies receiving 3 and 5 times the recommended dose once weekly for 13 weeks demonstrated a dose-related decrease in testicular maturation compared to untreated controls. HOW SUPPLIED: IVERHART MAX Chewable Tablets are available in four dosage strengths (see Dosage section) for dogs of different weights. Each strength comes in a box of 6 chewable tablets, packed 10 boxes per display box. STORAGE INFORMATION: Store at 20°C -25°C (68°F- 77°F), excursions permitted between 15°C-30°C (59°F- 86°F). Protect product from light. For technical assistance or to report adverse drug reactions, please call 1-800-338-3659. Manufactured by: Virbac AH, Inc. Fort Worth, TX 76137 NADA 141-257, Approved by FDA IVERHART MAX is a registered trademark of Virbac Corporation. © 2014 Virbac Corporation. All Rights Reserved. 6/14 14276 Stephen Jones, DVM, is the President of the American Heartworm Society and a general practitioner/practice partner at Lakeside Animal Hospital, Moncks Corner, South Carolina. He received his DVM from University of Georgia. Read more about Dr. Jones at lahmc.com/veterinarians.php.