DISEASE INFORMATION FACT SHEET Feline infectious peritonitis .FACT SHEET / Feline infectious peritonitis

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  • F A C T S H E E T

    Journal of Feline Medicine and Surgery (2013) 15, Supplementary File

    DISEASE INFORMATION FACT SHEETFeline infectious peritonitis

    ISFM and AAFP 2013

    This Disease Information Fact Sheet accompanies the 2013 AAFP Feline VaccinationAdvisory Panel Report published in the Journal of Feline Medicine and Surgery(2013), Volume 15, pp 785808.

    Disease facts

    Feline infectious peritonitis (FIP) is animmune-mediated disease triggered by infec-tion with a feline coronavirus (FCoV). FCoV isfound very commonly in cats; it is transmittedvia the oralfecal route between felids, but is not infectious to other species (includinghumans). Coronavirus-specific antibodies arepresent in up to 90% of cats in catteries and inup to 50% of cats in single-cat households, yet only about 5% of FCoV-infected cats willdevelop FIP in multiple-cat households.1Initially it was hypothesized that FCoV

    strains causing FIP were different from aviru-lent enteric FCoV strains. FCoV strains weresubdivided into two distinct biotypes, felineenteric coronavirus (FECV) and feline infec-tious peritonitis virus (FIPV). However, it isnow accepted that all FCoV types may inducesystemic infection and that those biotypesare not two different virus species, but ratherrepresent virulence variants of the samevirus.2 The precise process by which FIPdevelops is unclear, but there are two mainhypotheses.3 The most widely acceptedhypothesis, the internal mutation theory,assumes that a mutation is necessary to enablethe virus to replicate in macrophages.46 Catsare initially infected with the primarily aviru-lent FCoV, which replicates in enterocytes. Insome instances a mutation occurs in the FCoVgenome, resulting in a new phenotype withthe ability to replicate within macrophages.No consistent mutation has been identified. The second hypothesis is that any FCoV can

    cause FIP but that viral load and the individ-


    Margie A ScherkDVM Dip ABVP (Feline Practice)

    Advisory Panel Chair*

    Richard B FordDVM MS Dip ACVIM DACVPM (Hon)

    Rosalind M GaskellBVSc PhD MRCVS

    Katrin HartmannDr Med Vet Dr Med Vet Habil

    Dip ECVIM-CA

    Kate F HurleyDVM MPVM

    Michael R Lappin DVM PhD Dip ACVIM

    Julie K LevyDVM PhD Dip ACVIM

    Susan E LittleDVM Dip ABVP (Feline Practice)

    Shila K NordoneMS PhD

    Andrew H Sparkes BVetMed PhD DipECVIM


    *Corresponding author:Email: hypurr@aol.com

    uals immune response determine whetherFIP will develop.79 Taking viral genetics andhost immunity into account, it is likely thatboth theories play a role.3 In both hypotheses,the key pathogenic event in the developmentof FIP is replication of FCoV in macrophages. Affected cats develop a spectrum of clinical

    signs caused by 1) granulomatous lesions intarget organs, including central nervous sys-tem, eyes and parenchymatous organs or 2) vasculitis leading to fluid redistributioninto second spaces, accumulating in body cav-ities causing effusions (eg, abdominal[ascites], thoracic, pericardial, scrotal).3,10 Inaddition to these well known clinical presen-tations, some unusual pictures have beendescribed, including the development of afocal granulomatous mass causing intestinalobstruction,11 priapism,12 skin fragility,13 andother skin lesions (eg, nodular or papularlesions, pododermatitis).14,15

    The 2013 Report of the Feline VaccinationAdvisory Panel of the American Association ofFeline Practitioners (AAFP) provides practicalrecommendations to help clinicians selectappropriate vaccination schedules for their feline patients based on risk assessment. The recommendations rely on published data as much as possible, as well as consensus of amultidisciplinary panel of experts in immunology,infectious disease, internal medicine and clinical practice. The Report is endorsed by theInternational Society of Feline Medicine (ISFM).

    Reprints and permission: sagepub.co.uk/journalsPermissions.nav

  • Vaccine types

    A vaccine for FIP is commercially available inthe USA, Canada and Europe, and contains atemperature-sensitive modified-live mutantstrain of coronavirus for intranasal adminis-tration. The vaccine is not licensed for kittensyounger than 16 weeks of age because protec-tion from disease has not been demonstratedin these young animals. This vaccine wasdeveloped specifically to avoid induction ofhigh serum antibody levels as these may promote antibody-dependent enhancement(ADE) of infectivity (see vaccine safety).

    Onset and duration of immunity

    Controversy exists concerning the ability ofthis vaccine to protect from FCoV infection orto prevent development of disease; little isknown about onset and duration of immunity.The vaccine is licensed for annual revaccina-tion but the maximum duration of immunityhas not been determined. Some studies demonstrate protection from

    disease,16,17 while others show little or no benefit from vaccination.18,19 Discrepanciesbetween study results are likely attributable todifferences in the experimental setting of thechallenge trials (eg, strain and dose of chal-lenge virus, genetic predisposition of test ani-mals). In a field study of 138 cats belonging to15 cat breeders, in which virtually all of thecats had antibodies, no difference was foundin the development of FIP between the vacci-nated group and the placebo group.20 Thus,vaccination in households with known casesof FIP or in an FCoV-endemic (and thus high-risk) environment is not effective. In oneplacebo-controlled double-blind trial in agroup of cats lacking FCoV antibodies beforevaccination, a small but statistically signifi-cant reduction in the number of cats that sub-sequently developed FIP was noted.21 Theremight be certain special circumstances (eg, acat that has never been exposed to FCoVentering a shelter in which FCoV is endemic)in which the vaccine might induce some levelof protection.

    Vaccine safety

    Field studies have demonstrated that the com-mercially available vaccine is safe if used incats over 16 weeks of age. ADE leading tofaster development of disease in vaccinateswas demonstrated in experimental challengeexposure studies;18,22 however, ADE likelydoes not occur in a natural setting. In neitherof the two placebo-controlled, double-blindfield trials were signs of ADE or induction ofFIP noted.20,23

    Other vaccine considerations

    Most kittens born and reared in environmentsin which FCoV infection is endemic are infect-ed prior to 16 weeks of age. This may be onereason for the lack of vaccine efficacy in thefield.24,25If vaccination is considered, FCoV antibody

    testing should be performed before vaccinat-ing as the vaccine is ineffective once cats havebeen exposed to the virus. However, manyfactors, both intrinsic to the cat as well as asso-ciated with testing methodology, make inter-pretation of titers challenging.Antibody titers develop subsequent to vac-

    cination, making the establishment and moni-toring of an FCoV-free household difficult.

    FACT SH EET / Feline infectious peritonitis


    1 Addie DD, Toth S, Murray GD and Jarrett O.Risk of feline infectious peritonitis in cats nat-urally infected with feline coronavirus. Am JVet Res 1995; 56: 429434.

    2 Herrewegh AA, Vennema H, Horzinek MC,Rottier PJ and de Groot RJ. The moleculargenetics of feline coronaviruses: comparativesequence analysis of the ORF7a/7b transcrip-tion unit of different biotypes. Virology 1995;212: 622631.

    3 Addie D, Belak S, Boucraut-Baralon C, EgberinkH, Frymus T, Gruffydd-Jones T, et al. Felineinfectious peritonitis. ABCD guidelines onprevention and management. J Feline Med Surg2009; 11: 594604.

    4 Vennema H, Poland A, Foley J and Pedersen NC.Feline infectious peritonitis viruses arise bymutation from endemic feline enteric corona -viruses. Virology 1998; 243: 150157.

    5 Haijema BJ, Volders H and Rottier PJ. Live,attenuated coronavirus vaccines through thedirected deletion of group-specific genes provide protection against feline infectiousperitonitis. J Virol 2004; 78: 38633871.

    6 Rottier PJ, Nakamura K, Schellen P, Volders Hand Haijema BJ. Acquisition of macrophage tropism during the pathogenesis of felineinfectious peritonitis is determined by muta-tions in the feline coronavirus spike protein.J Virol 2005; 79: 1412214130.

    7 Poland AM, Vennema H, Foley JE and PedersenNC. Two related strains of feline infectiousperitonitis virus isolated from immunocom-promised cats infected with a feline entericcoronavirus. J Clin Microbiol 1996; 34: 31803184.

    At this time, there is insufficient evidence that the vaccine induces clinicallyrelevant protection, and use of the vaccine is not recommended.

    A d v i s o r y P a n e l R e c o m m e n d a t i o n s

    Journal of Feline Medicine and Surgery (2013) 15, Supplementary File

  • FACT SH EET / Feline infectious peritonitis

    8 Meli M, Kipar A, Muller C, Jenal K, Gnczi E,Borel N, et al. High viral loads despite absenceof clinical and pathological findings in catsexperimentally infected with feline corona -virus (FCoV) type I and in naturally FCoV-infected cats. J Feline Med Surg 2004; 6: 6981.

    9 Kipar A, Baptiste K, Barth A and Reinacher M.Natural FCoV infection: cats with FIP exhibitsignificantly higher viral loads than healthyinfected cats. J Feline Med Surg 2006; 8: 6972.

    10 Pedersen NC. A review of feline infectiousperitonitis virus infection: 19632008. J FelineMed Surg 2009; 11: 225258.

    11 Harvey CJ, Lopez JW and Hendrick MJ. Anuncommon intestinal manifestation of felineinfectious peritonitis: 26 cases (19861993).J Am Vet Med Assoc 1996; 209: 11171120.

    12 Rota A, Paltrinieri S, Jussich S, Ubertalli G andAppino S. Priapism in a castrated cat associatedwith feline infectious peritonitis. J Feline MedSurg 2008; 10: 18118