3 April 2014
Heartworm is a parasitic infection (primarily of dogs) caused by Dirofilaria immitis, which is spread by mosquitoes. In areas where the parasite is present, the standard recommendation is for preventive treatment of dogs during the mosquito season, and annual testing to make sure they don’t have the disease. Numerous types of heartworm medication are available, and there’s been considerable debate about the potential for emergence of heartworm resistance.
In some areas, there have been increasing numbers of reports of apparent failures of heartworm preventive medication. These cases can sometimes be explained by factors such as poor compliance (e.g. the owner forgot to give the medication or did not give it properly), unnoticed vomiting/regurgitation of oral medication, or encountering an infected mosquito outside of the normal transmission period (i.e. in areas where it’s a seasonal issue and medication is therefore not given year round). However, not all cases have clear explanations, and truly resistant heartworms have been identified.
Most of the concern has been focused around the inadvertent discovery of the “MP3” strain. For companies to be able to state that their product is effective against heartworm, they have to prove it in experimental studies using recent strains of the parasite. When the MP3 strain was used to test a potential new drug, they found out that it was actually resistant to the standard treatment.
A study in Veterinary Parasitology (Blagburn et al 2011) describes further testing that was done on this strain. The authors showed that only one of the four medications tested (imidacloprid/moxidectin) provided 100% protection in experimentally infected dogs with a single treatment.
At this point, there’s limited information about clinical cases of resistant heartworm, and most of the anecdotal reports come from the central US. The MP3 strain itself was found in a dog from northeast Georgia in 2006. A big question is whether this is:
- a small, focal, regional issue
- a regional issue that’s going to expand
- a wider but unidentified problem in many areas
There’s no way to know for sure without surveillance, but it is cause for concern.
What does resistant heartworm mean to the average dog owner?
I think it means the days of being able to justify not testing dogs annually, even if it’s certain that all heartworm medication has been given religiously since the last test, are over. Skipping annual testing was always a bit of a tenuous argument anyway, because of the potential for a dog to vomit or regurgitate oral medication, or to encounter an infected mosquito while not on medication, and it’s even weaker now that resistance might be an issue.
Why is heartworm testing more important now?
It’s important for two reasons. One is to make sure that heartworm is promptly diagnosed if it is present. This allows for earlier treatment before the parasites cause more damage. The other reason is to get information about whether resistant strains might be emerging in an area, which is helpful for the broader dog population. We have little information about the distribution of resistance, but if veterinarians start seeing heartworm cases in animals that have been properly treated with preventative medication, it’s an indication that resistance might be developing in the area.
At this point, people shouldn’t get too concerned about resistant heartworm, but we need to pay attention to the issue in case it increases or is in fact more widespread than we realize. Ongoing surveillance in different areas is needed to determine the scope of the problem, in terms of both the prevalence of resistant parasites and the impact on animal health. We need to be careful not to overreact, but at the same time we need to figure out what’s going on. Pet owners need to have conversations with their veterinarians about the need for heartworm prevention in their pet, and the optimal approach to testing and prevention.