Pet health is important because it impacts owners’ health too. Flea and tick infestations are just two conditions where pharmacists can provide advice and products, says Steve Titmarsh…

More than a quarter of cats (28.1 per cent) and about 1 in 7 dogs (14.4 per cent) in the UK are infected with fleas. Cat fleas (Ctenocephalides felis) are found in more than nine out of ten infected cats and dogs. Worldwide fleas are the most clinically important ectoparasites in cats and dogs.¹

Cat fleas have a four-stage life cycle: females lay pearly white eggs about 0.5mm long from which larvae hatch and go through three larval stages. Fully grown larvae spin a cocoon and pupate. Adults emerge up to six months later depending on local conditions.²

Fleas feed off the blood of their host, which can be a pet, human, bird, reptile or other wild animal.³ Signs that a pet may have fleas include:³

• Scratching more than normal
• Tiny dark specks in the fur
• Small browny-black insects on skin or fur
• Pet owners and their family have unaccounted for insect bites.

However, animals that are not allergic to fleas may show few, if any, symptoms: they may just scratch occasionally because of irritation by fleas or their bites. Grooming behaviour will also determine the level of infection and therefore whether fleas are detected.²

Pets can be checked by grooming with a flea comb and wiping it onto a piece of white paper to make fleas and flea droppings visible. If droppings turn a reddish-brown in contact with a small amount of water a flea infestation is likely.³

Infection

Preventing exposure to fleas is almost impossible. Pets can come into contact with them outdoors and at home. Fleas can jump up to 20cm (around 150 times their own length). During its lifetime a female can lay 2,000 eggs, and a flea can live for more than 100 days without food. ³

DNA analysis showed that 66 pets from a sample of 470 carried a pathogen, most commonly Bartonellaspecies, which can cause disease in humans after a bite or scratch from an animal.

Infection with these bacteria is linked to mild symptoms such as fever and headache as well as more severe neurological symptoms such as hallucinations.⁴ The disease is relatively rare – 6.4 cases per 100,000 population in adults and 9.4 cases per 100,000 in children aged 5–9 years globally.⁵

How to control fleas

Regular preventive measures are needed to control fleas, such as a topical, oral or injectable parasiticide.³ It is important to treat all pets in a household.² Hygiene is important, including:³

• Regular washing of pet bedding at 60C
• Vacuuming floors, skirting and furniture regularly, being careful to empty the vacuum straight away
• Spraying bedding and furniture with a flea spray
• Regularly grooming pets to spot early signs of infestation.

Ongoing control and prevention of infestations depends on several factors, including the number of pets in a household, level of infestation, access to areas where reinfection is likely and to some extent time of year. Although flea infestation can happen year-round, it peaks in summer and autumn.²

Where infestation risk is minimal regular grooming and visual inspection with treatment when evidence of infestation is found may be all that is necessary.

Where animals are regularly going outside where there is a moderate risk of infestation regular treatment of pets at recommended intervals is needed along with daily cleaning, such as vacuuming of their environment.

Animals in multi-pet households, pet shelters, and animal breeder’s premises are at high risk of reinfestation and usually require monthly application of insecticides as well as regular cleaning and treatment of their environment. ²

Ticks

Most ticks found on cats and dogs in the UK are Ixodes species. Like fleas, they are parasites that feed on their hosts’ blood. ² Tick infestation peaks in March to June and August to November in the UK. ²

Ticks can be found all over the body but particularly in hairless areas and where the skin is thin, for example face, ears, axillae, interdigital, inguinal and perianal regions. They are easily spotted because once full of blood they are about 1cm long. ²

Ticks can cause a variety of health problems since they carry bacteria, viruses, protozoa and nematodes that can infect pets and humans. Diseases affecting pets and humans include bartonellosis, Lyme disease, anaplasmosis and Q fever. ²

Ticks should be removed with a specially designed tool as soon as they are spotted. Pets may then need treatment for tick-borne disease. Humans who contract Lyme disease, for example, may need antibiotic treatment.⁶

Avoiding exposure is important. The tick season is usually between March and October. As well as pets, ticks feed off a range of animals, including squirrels, deer, sheep and garden birds. It is advisable to avoid walking in long grass, to wear long-sleeved shirts and tuck trousers into socks when out walking in the countryside.⁷

What role can pharmacies play?

Andrea Tarr, a pharmacist and founder/director of Veterinary Prescriber, explains that pharmacists are entitled by the Veterinary Medicines Regulations to supply POM-V medicines in response to a prescription from a vet

They can also independently supply POM-VPS medicines (mainly parasiticides, vaccines and supplements for farm animals) and NFA-VPS medicines - parasiticides for companion animals (see also www.gov.uk/guidance/retail-of-veterinary-medicines).

She believes pharmacists are well placed, due to their accessibility and from a ‘one health’ perspective,⁸ to communicate with pet owners about medicines, but sadly she feels there is an enormous deficiency in pharmacists' knowledge about veterinary medicines.

Knowledge about the common parasite diseases in companion animals is essential. So is product knowledge, including awareness of safety aspects, not least environmental safety, and where to find reliable information on veterinary medicines to support dispensing of POM-Vs as well as OTC sales.

Andrea believes there is little information about veterinary pharmacy at undergraduate level and no postgraduate study options apart from the suitably qualified person (SQP) qualification (see www.veterinaryprescriber.org/free-articles/become-a-veterinary-pharmacist).

Her advice is to look for educational material (see the link above) to gain an understanding of veterinary medicines regulations, learn about parasite disease and products, understand about their safe use (for example, www.veterinaryprescriber.org/free-articles/is-there-a-pet-parasiticide-that-is-safer-for-the-environment) and aim to be a trustworthy evidence-based source of information on veterinary medicines. It is also a good idea to get to know your local veterinary practices.

A spokesman for the RSPCA said: “The RSPCA also welcomes any initiatives that help get more information on good welfare and pet care advice to owners – and to improve the accessibility of support. Many of the welfare problems we see every day could be avoided through early support, intervention and advice.

“The veterinary profession is under huge pressure right now – so providing advice and support to pet owners from community pharmacies could be one idea to help alleviate that. However, this would require appropriate, species-specific training for staff – and significant discussion between the pharmaceutical and veterinary professions about how any such scheme could work in practice.”

References 

1. Abdullah S, Helps C, Tasker S, et al. Pathogens in fleas collected from cats and dogs: distribution and prevalence in the UK. Parasites Vectors 2019;12:71.
2. ESCCAP (European Scientific Counsel Companion Animal Parasites). Control of Ectoparasites in Dogs and Cats. ESCCAP Guideline 03 Sixth Edition – March 2018 (www.esccapuk.org.uk/uploads/docs/ke4lxx07_0720_ESCCAP_Guideline_GL3_v9_1p.pdf; accessed March 2023).
3. Royal Veterinary College University of London. Flea prevention and treatments (www.rvc.ac.uk/small-animal-vet/general-practice/practice-services/pet-fleas; accessed March 2022).
4. Cheslock MA, Embers ME. Human Bartonellosis: An Underappreciated Public Health Problem? Trop Med Infect Dis 2019;4(2):69.
5. Mada PK, Zulfiqar H, Chandransesan AJS. Bartonellosis. Stat Pearls [Internet] (www.ncbi.nlm.nih.gov/books/NBK430874; accessed February 2023).
6. NHS.UK. Lyme disease (www.nhs.uk/conditions/lyme-disease; accessed March 2023).
7. NHS Inform. Tick bites (www.nhsinform.scot/illnesses-and-conditions/injuries/skin-injuries/tick-bites; accessed March 2023).
8. World Health Organization. One health (www.who.int/health-topics/one-health#tab=tab_1; accessed March 2023)