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From: Erin Rebecca Miller <[email protected]>
Subject: rec.pets.cats:  Feline Infectious Peritonitis FAQ
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                    Feline Infectious Peritonitis FAQ

  Contents:
    * Disclaimers
    * Summary
    * General Information about FIP
    * Multi-Cat Household/Cattery Management
    * References

  The main author of this FAQ is Erin Miller [[email protected]].
  However, this FAQ could never have been written without the
  information, editing, re-writing and general encouragement of Norman
  Auspitz [L13264%[email protected]]. Also thanks to
  Lorraine Shelton
  [[email protected]] for her
  advice and references.

  The purpose of this FAQ is to answer frequently asked questions about
  Feline Infectious Peritonitis (FIP), which is one of the most
  difficult diseases in the feline community today. This FAQ is divided
  into two parts, the first is general information about the disease,
  and the second is about management of FIP in a multi-cat and cattery
  environment. The sources for this FAQ are listed at the end, as well
  as some additional recommended readings. Recently an excellent source
  of information on FIP has become available on the WWW as well. This
  article is much more technical and many cat owners may find it much
  more dense than this FAQ. However, if you are interested it cat be
  found at: http://www.mother.com/~vin/fipnew.htm. There is also some
  information about FIP put out by Cornell at:
  http://web.vet.cornell.edu/public/fhc/fip.htm.

 Disclaimer:

  I want to point out first and foremost that I am not a veterinarian,
  nor even a person who has training in animal science such as a
  veterinary technician. I am a graduate student of physical
  anthropology, and an ailurophile. My goal with these FAQs is to take
  information from the medical literature and convey the parts that are
  most useful to the average cat owner and translate them into general
  terms that are easy to understand. I attempted to keep the FAQ as
  untechnical as possible, but unfortunately with such a complex disease
  that becomes very difficult. I hope this prooves to be of some
  usefulness. Also keep in mind that this disease is one of the most
  controversial subjects in feline health care. This is not a definitive
  guide to FIP, but only an attempt to compile the most current
  information. Ideally the reader of this FAQ should use this as a
  starting point when discussing FIP with their veterinarian. Vets and
  breeders will hold a wide variety of opinions on this disease, some of
  which may be based on current information, some of which may be based
  on hearsay and anecdotal evidence. You can only do your best to become
  as educated as possible and make your decisions on the course of
  treatment or preventive care. Always remember, your cats is YOUR
  responsibility, and no one, not your vet, not a breeder, not a
  friend-who-knows-everything-there-is-to-know-about-cats, nor the
  writer of an internet FAQ can force you do take an action that you
  don't feel comfortable with. Do what you think is best for your cat.
  Period.
    _________________________________________________________________

                                 Summary

  To begin and unfortunately in sum: There is NO effective treatment,
  there is NO diagnostic test, there is NO way to positively identify
  asymptomatic carriers (cats which shed the virus, but do not
  themselves show outward signs of illness), the incubation time is
  UNKNOWN, NO one is 100% sure of how it is spread between cats, and
  there is NO proven effective way to control its spread in a multi-cat
  household or cattery. So what is known? Read on.
    _________________________________________________________________

PART I: General Information about FIP

  I've heard FIP is like AIDS. Can I catch AIDS or anything else from
  it?
  People often use the "it's like AIDS" phrase to describe a number of
      illnesses in the animal (and human) community with the idea that
      most people know so much about AIDS that this analogy is useful.
      Unfortunately most people don't know much about AIDS and the
      resulting effect is to scare people out of their wits and have
      them dump their cats or dogs at the nearest pound because they are
      so deathly afraid of catching AIDS from them. The ONLY similarity
      between FIP, FIV (Feline Immunodeficiency Virus) and FeLV (Feline
      Leukemia Virus) to HIV (which is believed to cause AIDS) is in
      their genetic makeup. All are RNA (as opposed to DNA) viruses, and
      FeLV and FIV (and HIV) are what are known as "retroviruses." FIP
      is a type of "coronavirus" which makes it even less similar to
      HIV. To make it clear: THERE IS ABSOLUTELY NO WAY TO CATCH AIDS
      FROM A CAT, NO MATTER WHAT FELINE DISEASE THAT ANIMAL MAY HAVE.
      See the FeLV FAQ for more information on retroviruses.

  So what *is* FIP?
  FIP is not caused by a retrovirus but by a type of coronavirus. One of
      the reasons FIP is such a problem for vets is because there may be
      no way to differentiate an FIP virus from certain other viruses.
      Current thinking is that FIP is caused by a mutation of the Feline
      Enteric Coronavirus (FECV). FECV is very common, and an FECV
      infection can have symptoms ranging from none, to flu-like with or
      without diarrhea. These are most common in kittens, but can occur
      in cats of any age. If the immune system is not functioning
      properly, a mutant FECV can become a more systemic infection that
      we call FIP. All FIP tests appear to react the same way to every
      type of coronavirus. So, if your cat had FECV as a kitten, it may
      cause the same reaction in the current test as true FIP (more on
      the tests below).
      For the purpose of this FAQ, however, I am going to continue
      referring to an "FIP Virus" or "FIPV." Just keep in mind that in
      fact, there may not be a difference between FIPV and FECV per se,
      just a difference in the way a cat's immune system responds.

  What are the symptoms of FIP?
  FIP usually appears in one of two forms: Effusive (wet) and
      Non-Effusive (dry). It should not be thought, however, that there
      are two different FIP diseases. The results of the infection are a
      continuum on a scale, with the 'wet version' being one end, the
      'dry version' being in the middle, and a 'carrier' being the other
      end (a carrier is where the cat has successfully fought off the
      disease but may still be able to expose other cats to the virus).
      The way this happens is when a cat is exposed to FIPV, if its
      immune system gives a poor response, the wet form will develop. If
      it gives a better response, the dry form will develop. In the best
      responses, the cat will not develop either form of FIP, although
      it may be a carrier of the FIP virus.
      Wet
      The wet form is more common, and more rapid in progression than
      the dry form. It is characterized by the abdomen and/or chest
      progressively but painlessly distending with fluid. If this occurs
      in the chest, respiratory distress can occur due to compression of
      the lungs and release of fluid into the airways. The lining of the
      affected cavity will be covered with white, fibrin-containing
      areas (fibrin is a protein that is the center of a blood clot),
      often on the liver and spleen. Certain types of lymph nodes may be
      enlarged. Other signs include jaundice; mild anemia; and
      gastrointestinal, ocular (e.g. eye ulcers or severe
      conjunctivitis), and neurological signs may also occur.
      Dry
      The dry form is more rare (but appears to be becoming more
      common), and more slow in progression, often making diagnosis
      difficult. There is minimal fluid build-up, although weight loss,
      depression, anemia, and fever are almost always present. Signs of
      kidney failure, liver failure, pancreatic disease, neurologic
      disease or ocular disease may be seen in various combinations.
      Often the organs in question develop a characteristic
      pyogranulomatous inflammation (this is a chronic inflammation
      resulting in a thickening of the tissue and local accumulation of
      white blood cells). Unfortunately biopsy of these lesions is the
      only definitive way to diagnose this form of FIP and is usually
      done in the form of a post-mortem diagnosis.

  What are the differences between FIP and FECV?
  FIP is a disease. Normally the disease/virus relationship is simple,
      but this is not the case with FIP. FIP may be caused by many
      things, perhaps an isolated FIP virus (FIPV), perhaps a mutation
      of FECV, or perhaps there are multiples viruses which can all lead
      the the same disease complex known as FIP. There is little
      question, however, that the most common cause of FIP is via FECV.
      For the most part, FECV is limited largely to the intestines and
      is dealt with quite well by the cat's immune system. However, as
      recent studies seem to indicate, FECV can mutate into FIP and, if
      the cat's immune system is not operating properly, this mutant
      FECV stops being just an infection of the intestine and becomes
      the more systemic infection we call FIP.
      Thus, wherever you have FECV you could have FIP! Some cats never
      get FIP, but can continue to shed the FECV virus (now thought to
      be spread via the feces). The good news, however, is that since it
      seems that the dry form is becoming more prevalent, that cats are
      gradually becoming more able to resist FIP infection in general.

  Is my cat at high risk?
  If it comes in regular contact with other cats (i.e.: an
      indoor/outdoor cat), the answer is YES! The lowest risk groups are
      indoor only, single-cat households. The higher the number of cats,
      the more risk of FIP. The higher the number of cats, the higher
      the titer test results (more on titers below). Single-cat
      households are generally free of all coronaviruses. FIP occurs in
      greatest incidence in cats between six months and two years old,
      although infections are high up to five years old. Of course the
      most susceptible group to catching FIPV are kittens because under
      the age of 16 weeks their immune system is very bad in general.
      Studies also show that poor nutrition, high stress levels or poor
      husbandry increase the likelihood of getting FIP. Outside
      exposure, exchanging of animals, especially kittens and young
      cats, highly inbred cats, and cats in actively breeding households
      increase the risk. Males and females are equally affected.

  How is it transmitted?
  Wouldn't we all like to know! Seriously, there seems to be two schools
      of thought. One group (from Cornell-based publications and
      seminars) states that the spread is not known with certainty, but
      is believed to be by ingestion or inhalation of the virus. The
      other school of thought (from Dr. Pedersen and the UC, Davis based
      publications) believes that transmission is most prevalent when
      cats have close contact with other infected cats or their
      feces/urine. Both schools seem to feel that feces may play a large
      role in the method of transmission.
      Some studies suggest that viruses that can cause FIP can survive
      on dry surfaces (food/water bowls, litter boxes, human clothing,
      etc.) and can survive at room temperature probably up to 2 or 3
      weeks. If this is the case, then the two schools of thought on
      methods of transmission may not be so far apart, especially given
      that litter can contain dust to which small particles of feces can
      adhere. Thus the virus can possibly be spread via litter dust on
      shoes or clothing or etc. making it behave as if it were an
      airborne virus!

  If the virus can last so long on dry surfaces, what happens if I
  unknowingly come in contact with a cat with FIP? Can I give it to my
  cats?
  Most household soaps, detergents and disinfecting agents will kill the
      virus. Make sure you wash any part thoroughly that has come in
      contact with the cat (don't forget your pants if the cat rubbed up
      against you). Bleach in a 1:32 solution is suggested for
      decontamination purposes.

  Is there a test?
  There is a test which will look for the presence of coronavirus
      antibodies in your cat's blood. If your cat has been exposed to a
      coronavirus, ANY coronavirus, its immune system will build up
      antibodies to it, and the titer tests for the level of those
      antibodies in the blood. But it does not distinguish between
      antibodies made specifically against FIP, or FECV, or any other
      coronavirus. A positive titer means only that your cat has created
      antibodies (therefore been exposed to) SOME form of coronavirus.
      The higher the titer, the more antibodies the cat has created.
      As if there were not enough problems with the coronavirus test,
      there is no uniformity between different labs. One cannot compare
      results from one lab to another. Some labs just specify positive
      or negative if the results are above or below a given titer (often
      these labs do not even specify the titer). There are no standards
      for setting up a lab, there is no regulatory body that oversees
      them, and no requirement for validation of test results. It is
      also possible for a cat which has received the vaccine (more
      below) to have enough antibodies to appear on the titer test. To
      top it all off, false positives occur in up to 30% of the tests.
      In sum: DO NOT PLACE MUCH CREDENCE IN THE TITER TEST, AND UNDER NO
      CIRCUMSTANCES SHOULD A CAT BE EUTHANIZED BASED SOLELY ON THE
      RESULTS OF THE TITER TEST.
      There are some clinical indicators which your vet may discuss with
      you if s/he suspects that a cat has FIP, particularly if it is
      showing likely symptoms. Some blood tests can help your vet
      pinpoint FIP as a cause for your cat's condition, this includes
      looking for a high amount of gamma globulin proteins and a low
      amount of albumin proteins in the blood.
      There has also been talk of a polymerase chain reaction (PCR)
      test, in the hopes that it can tell the difference between FIP and
      other coronaviruses. Significant scientific studies have yet to be
      concluded on this method. However, given that the most common way
      of a cat coming down with FIP is via the mutation of FECV, this
      test may have little or no value in the great majority of cases.

  What about the vaccine?
  There is a vaccine available, but it is controversial and some vets do
      not recommend it, although others highly encourage it. The
      manufacturer's tests state that it has an efficacy rate
      (protection rate in this case) of 69%. Cornell Feline Health
      Center then did a study which said the vaccine failed to show any
      protection, and that it accelerated the disease in 52.5% of
      exposed cats. However, this study used a different challenge virus
      strain and the route of administration was different than the
      manufacturer's tests. The 'real-life' significance of this has not
      yet been determined, neither Cornell nor the manufacture has
      received reports from the field of abnormally high numbers of cats
      which get the disease as a result of the vaccine. However, this
      study has caused a lot of people to swear-off the vaccine.
      It really is between an individual cat owner and their vet to
      determine the whether or not to vaccinate based on the best
      information available at the time.

  So are these the only test results?
  Well, Cornell concluded from the above that vaccine efficacy in a
      laboratory setting is highly dependent on the challenge. It offers
      protection at low challenge doses, none at higher doses. The
      problem is, no one knows what the "real world" dose level is.
      Another problem is that there are actually two strains of FIPV.
      Just as there are many different flu strains or cold strains which
      cause you to get sick several different times with the flu or a
      cold, because each time you catch a different strain for which you
      aren't already immune. Type I strain of FIP is believed to be the
      most prevalent in the "real world" but it is the most difficult to
      reproduce in a laboratory. Type II is easier to reproduce, but not
      as prevalent outside. It is not known how effective a vaccine
      against one type will be against the other type.
      So, while some of the studies have found the current vaccine
      effective against the Type II strain of FIP, there is no evidence
      either way as to if it will work against the Type I strain.

  So that is Cornell's opinion, are there any other points of view?
  The consensus arrived at the seminar sponsored by the Winn Foundation
      on FIP/FECV is that the enhanced disease effect is a laboratory
      phenomenon, especially since that study by Cornell only used
      seropositive cats in the first place.

  What is a seropositive cat?
  Some cats test positive on the coronavirus titer test, some do not.
      Those which have never been exposed to ANY form of coronavirus are
      called "seronegative." Those which have been exposed to some form
      of coronavirus are called "seropositive." The Winn
      Foundation-sponsored research felt the Cornell study was flawed
      because it used cats which had already been exposed to some form
      of coronavirus (were "seropositive") and then attempted to test
      the vaccine.
      This is not to be confused with the terms "FIP negative" and "FIP
      positive" which are used by many labs to indicate that the
      coronavirus titer is less than (negative) or more than (positive)
      some predefined threshold level.

  Have there been any more recent studies?
  Yes. In another, recent study cats were tested in the same manner as
      in the vaccine manufacturer's tests. At the end of an 8-week
      period, 30% of cats vaccinated, and 60% of the controls
      demonstrated FIP-positive conditions from tissue examinations.
      This demonstrates a 50% "preventable percentage."
      Another recent field trial ran for 16 months using 500 cats in a
      no-kill shelter with endemic FIP. The fact that this is a shelter
      makes it a different makeup than a cattery (and some multi-cat
      households) because the average age of a cat was approximately 2
      years old, and there were no kittens under 16 weeks old. However
      ALL cats tested were seronegative prior to exposure in the
      shelter. During the time of the study, 0.8% of the vaccinated cats
      died and 3.25% of controls died of FIP. [This is statistically
      significant at p=.048, which means that there is a 95.2%
      probability that this result is not random] So, for seronegative
      cats over the age of 16 weeks, this study shows a 75% efficacy
      rate. Vaccination after exposure (after a cat is already
      seropositive) is not likely to be helpful in preventing the
      disease.

  So what does this all mean?
  In sum, if you know your cats are seronegative, and they are older
      than 16 weeks, the vaccine is recommended by both the Cornell
      Feline Health Center and the consensus reached at the Winn
      Foundation sponsored FIP/FECV seminar. If your cat is already
      seropositive, there is not much evidence that the vaccine will
      help.
      The vaccine will be more of a help when

    * the manufacturers demonstrate its effectiveness against the Type I
      strain of FIP
    * it is shown to be effective in seropositive cats, and
    * it could be shown to be safe and effective for kittens under the
      age of 16 weeks.

  However, it appears that there is work being done to develop a FECV
  vaccine. Preventing FECV infections in the first place, and thus
  preventing FECV from mutating into FIP, might turn out to be another
  technique in trying to protect against FIP.

  My vet believes that my cat has FIP, what is the best thing to do?
  Usually by the time the vet is able to pinpoint FIP as the cause of
      your cat's condition, the cat is pretty far along. So long as your
      cat is in pretty good shape, not in any pain or discomfort, there
      is no reason to euthanize it. Even if your cat is happy and
      healthy, however, you MUST make sure you keep it indoors and away
      from other cats. If you feel that this will be too great a
      compromise on its quality of life, it is better to euthanize it.
      Since the cause of transmission is not known, by allowing your
      FIP+ cat outside, you could cause numerous other cats to become
      ill, and even further spread the disease. But please keep your
      cat's welfare foremost in your mind. When its systems begin to
      fail, when it is in obvious discomfort, you are only making things
      worse by delaying the inevitable. Keep him or her as happy and as
      comfortable for as long as possible, that is unfortunately the
      only solution at this point.
    _________________________________________________________________

PART II: Multi-Cat Household/Cattery Management

  I have a lot of cats, what can I do to keep the risk of FIP down?
  Limit the number of new cats and isolate each for at least one month,
      preferably two. I know it sounds like a long period of time, but
      consider the alternatives! You could lose every cat in your
      household. During the one month's time period, make sure you watch
      carefully for signs of illness. You should give the coronavirus
      titer test at the beginning and the end of the quarantine period,
      and the titer should decrease over that time period.
      Scoop the litter box daily, discard the rest of the litter weekly
      and disinfect the boxes with a 1:32 solution of bleach. The area
      around the boxes should be swept and disinfected, there should be
      at least one box for every two cats in the household. Again,
      weekly discarding of the scoopable litter may seem like a waste,
      but so far the ONLY thing the sources agree upon with regard to
      transmission is that it is definitely transmitted through the
      feces, if nothing else. In the words of one breeder: "It cost me
      approximately $3,000 in veterinary and laboratory services to
      diagnose the incidence of FIP in my cattery, test and retest (and
      retest) all of my cats. Believe me it is FAR less expensive to
      discard the litter" (Polli, p. 81). If your cats have long hair
      and fecal matter tends to stick to the britches, this hair should
      be kept clipped short.
      Change food and water daily, disinfect the bowls weekly. Do not
      mix the bowls all around the house, keep the same set of bowls
      with the same cats, and keep the same set of litter boxes with the
      same cats.

  What if one of my cats if pregnant?
  It is suggested that queens be completely isolated from other cats
      (isolated in its own room, not its own cage within a room). This
      room should be empty for one week prior to placing the queen
      there, and should be disinfected with a 1:32 solution of bleach.
      The queen should be placed in the isolation room 10-14 days prior
      to delivery. All bowls and litter boxes should be used exclusively
      for that room, and not interchanged with any others. You should
      disinfect your hands when entering and leaving the isolation room.
      If possible, you should even try to have separate clothing, such
      as a smock and slippers which are restricted to the isolation room
      to decrease risk.
      If the queen is not seronegative, you may want to consider an
      early weaning program. The queen should be removed from the
      kittens at age 4-6 weeks and never returned. During the first 4-6
      weeks of a kitten's life, it gets its antibodies from their
      mother, therefore they are immune to anything she may be shedding.
      After that time period, they start making their own antibodies. If
      the queen is a carrier of coronaviruses, she can shed FECV to the
      kittens, and they are most likely to become infected during that
      time period. Regardless of whether the kittens are weaned early
      and isolated from the mother, they should be kept isolated from
      all other cats in the household. In addition to minimizing the
      risk of the kittens developing FIP, the risk of exposure to other
      viruses and diseases will be reduced.
      Kittens should be raised in complete isolation from the queen and
      all other cats/kittens in the household until they leave the
      cattery. If the kitten is to be kept in the cattery, it should be
      isolated for 16 weeks, and then the FIP vaccination series should
      be completed before allowing the kittens to interact with the
      other cats.

  Is there any evidence for this?
  A 1992 study found the following: 400 kittens were divided into 41
      household with various FIP histories. In one group the kittens
      were allowed to freely associate with all the cats. In a second
      group the kittens were isolated only with their mother. In the
      third group, the kittens were isolated by themselves starting at
      age 2-6 weeks. Only in this last group did all of the kittens
      remain seronegative for any/all coronaviruses.

  That sounds absolutely ridiculous! Who would go through all that?
  Nobody says a breeder HAS to do any of this. These are merely the
      precautions currently recommended by the Cornell Feline Health
      Center and the recommendations which came out of the Winn
      Foundation sponsored Seminar on FIP/FECV. It is an option kitten
      buyers can use in determining which breeder to select if they so
      choose, but it is by no mean mandatory.
    _________________________________________________________________

References:

    * Polli, Leigh. "Highlights from The Winn Feline Foundation
      International FIP/FECV Workshop." Cat Fanciers Almanac, 11(8),
      December 1994.
    * Richards, James R. DVM. "Management of Coronavirus Infections in
      Catteries and Multicat Households." Comprehensive Seminar for Cat
      Breeders Cornell University School of Continuing Education and
      Summer Sessions.
    * Siegal, Mordecai (ed.) Cornell Book of Cats: Comprehensive Medical
      Reference for Every Cat and Kitten. New York: Villard Books, 1991.

 Additional Readings:

    * Addie, D.D. and Jarret, O. "A Study of Naturally Occuring Feline
      Coronavirus Infections in Kittens." Vet Record Feb. 15, 1992.
    * Barlough, J. E. and Stoddart, C.A. "Feline Infections
      Peritonitis." Cornell Feline Health Center Information Bulletin 6,
      8/84.
    * Olsen, C, and Scott, F.W. "Feline Peritonitis Vaccination - Past
      and Present." Feline Health Record Topics for Veterinarians 6(20),
      Spring 1991.
    * Scott, F.W., Corapi, W.V., and Olsen, C.W. "Evaluation of the
      Safety and Efficacy of Primucell FIP Vaccine." Perspectives on
      Cats, Fall 1992
    * Richards, J.R. "FIP: The Challenge Continues." Cat Fancy 36(5):
      May 1993.
      Papers in Feline Practice Volume 23, Number 3. May/June 1995
    * Addie D.D., Jarett O. Control of Feline Coronavirus Infections in
      Breeding Catteries by Serotesting, Isolation, and Early Weaning.
      Feline Practice 23(3), 92-95, 1995.
    * Addie D.D., Toth S., Murray G.D., Jarett O. The Risk of Typical
      and Antibody Ehhanced Feline Infectious Peritonitis Among Cats
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