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ANTI-TICK SERA (Australia)

It is now mandatory for all marketed antisera to contain more than 500 CSIRO antitoxin units per mL. The recommended dose rate is generally 5000 CSIRO units per 20 kg dog (10 mL) for up to stage 3 paralysis. An in vitro/in vivo neutralisation test using the mouse as the test animal has been developed to estimate the antibody titre in batches of antisera. Individual manufacturers, however, may use different methods of calculating dosages (see below). Because of the wide range in biological conditions applying to each case predictable results are difficult to achieve or even expect. Ultimately doses must be adjusted to the response. Giving antiserum early appears to be important. It has been estimated that every mL of antiserum given at the initial treatment is worth 5 mL given 24 hours later (Jones, 1991). The sera that are or have been available are: Lismore, North Coast, CSL, and AVSL. Note that the terms "tick antiserum", "anti-tick serum" and "tick antivenom" are used synonymously. Please also note that these notes are for background information only and that the information may not always be fully up to date.

Lismore Supreme Serums

Lismore Supreme Serums
Dalwood Road, Alstonville, NSW
telephone (066) 295284

This company makes two kinds of serum- normal and so-called "de-specified" (ie with species-specific components removed).

1. Canine Anti-Tick Serum: minimum 500 A.T.T.
   50mL, batch #, contains 0.25% phenol as preservative, store 2-8 deg C
   cats 5 mL I.P.
   dogs 10-20 mL I.V.
   goats, sheep, pigs 5-10 mL I.P.
   foals, calves 10-20 mL I.P.
   
2. Despecified Anti-Tick Serum: minimum 500 A.T.T.
   20 mL, batch #, contains thiomersal 0.1 mg/mL as a preservative, store at 2-8 deg C
   cats 1-4 mL I.V.
   dogs 5-12 mL I.V.
   goats, sheep, pigs 3-12 mL I.V.
   foals, calves 5-15 mL I.V.

North Coast Serum Products

Canine Paralysis Tick Antiserum

Active constituent: >500 antitoxin per mL

Dosage:
dogs 10-30 mL IV
cats 10 mL (5 mL IV 5 mL SC)
calves 10 mL IM or IV foals 50 mL IV sheep 10-20 mL IV or IM

For use by or under the supervision of veterinary surgeon. Registered under the Stock Foods and Medicines act 1940 NSW.

North Coast Serum Products, 1295 Hogarth Range Road, Hogarth Range, NSW; (02) 6664 7270)

Store at 2-8 deg C (REFRIGERATE, DO NOT FREEZE).

Minimise exposure to light.

Net contents 50 mL. Batch No:....Exp date:...

CSL Anti-Tick Serum

Commonwealth Serum Laboratories Ltd, 45 Poplar Road , Parkville , Vic 3052; tel (03)3891356, (008)333301, FAX (03)3891646, CSL Website

Apparently CSL have stopped producing the human antiserum, and these days very few hospitals have any remaining stocks (S Doggett pers. com.).

Tick Antivenom suitable for human use

Composition. Antivenom is prepared from dogs hyperimmunised against the venom of Ixodes holocyclus. Each mL is capable of neutralising at least 20 mouse lethal doses.

Actions. Ixodes holocyclus is the common "bush" tick common along the entire east coast of Australia from northern Quensland to Lakes Entrance in Victoria. Fatal infestations are rare but nonfatal infestations are common, particularly among children.

Indications. Treatment of paralysis in humans caused by Ixodes holocyclus.

Precautions. As tick antivenom is heterologous to humans, untoward reactions may follow its injection. Such reactions are more likely to occur in those who have a personal or familial history of allergy or who have previously received canine antiserum. Adrenalin 1:1000 should always be kept on hand and ready for use whenever antivenom is administered.

Adverse reactions. Any of the following signs and symptoms may occur in varying degrees of severity: pallor, rapidity of pulse, general sensations of heat, itchiness or urticaria, swelling of the tongue or lips, an irritating cough, breathlessness or wheeziness, tightness in the throat or chest, nausea or vomiting, abdominal pains or discomfort, giddiness or loss of consciousness or convulsions.

Treatment of anaphylactic reactions. If a constitutional reaction should develop, the following lines of treatment should be adopted: 1) adrenaline 1:1000, give up to 0.5 mL intramuscularly if severe, repeat in 10 mins if recovery is not complete; in milder reactions adrenaline may be given subcutaneously and more slowly. 2) antihistamines may be given intramuscularly to supplement but not replace adrenaline; they are particularly useful if marked urticarial reactions develop. 3) an intravenous corticoid should be resorted to if the foregoing measures are not successful.

Serum sickness. Ths may occur after the administration of Tick Antivenom, but this is neither predictable nor preventable.

It should be noted that tick saliva also possesses allergenic properties and has caused hypersensitivity in some persons to an extreme degree. The most common allergic manifestations are urticaria and angioneurotic oedema.

Dosage and Administration. The antivenom must be given in adequate dosage if satisfactory results are to be achieved. If paralysis is evident, at least 20 mL should be given slowly by intravenous infusion. The antivenom should be diluted 1 in 10 in Hartmanns solution or normal saline.

Parenteral antihistamine cover should precede antivenom. Some clinicians also give a small subcutaneous dose of adrenaline as well as antihistamine. If symptoms persist or the patient's condition deteriorates, the dose should be repeated or increased.

Note. Tick antivenom is supplied as a sterile, freeze-dried powder. Before use the contents of the bottle and the diluent should be allowed to reach room temperature. Add the volume of sterile diluent indicated on the label (Water for Injections BP 10 mL). The powder is dissolved by rotating the bottle gently so that solution occurs without undue frothing. Caution- no antiseptic added. The reconstituted material should be used immediately and any unused solution should be discarded.

Presentation. Injection: 10 mL

Storage. Store at 2 to 8 degrees C. Do not freeze. Protect from light.

Poisons Schedule. S4

Reference: 

 Tick Antivenom, CSL Ltd: product information. MIMS Annual 1994

AVSL- Ixodes holocylus Antivenom

Manufactured by Australian Veterinary Serum Laboratories (AVSL)

The product: This antivenom is prepeared by hyperimmunising dogs against the potent toxin produced by Ixodes holocyclus. The antivenom contains concentrated antitoxic gamma globulins. The difficulties previously experienced in isolating the specifictoxin produced by Ixodes spp in quantitiy have been overcome to a degree. Experimental work carried by CSIRO has resulted in the development of a mouse-based toxin neutralising antibody test for the quantitative estimation of this Ixodes holocylus antivenom. Each batch of this product marketed now contains more than 500 CSIRO units of antitoxin per millilitre of product. Before presentation each batch of AVSL antivenom is also evaluated clinically by injecting graded doses intravenously into dogs which have been deliberately loaded with numbers of Ixodes holocyclus ticks.
This product contains 0.22 mL% of Phenol as a preservative.

Precautions in administration of AVSL Antivenom: Anaphylactic reactions in the canine after previous injection of AVSL antivenom have been found to be rare. However, the possibillity of its occurrence when subsequent intravenous injections are administered after a fourteen day sensitising period should be recognised, and appropropriate precautions taken. When administering AVSL antivenom to cats, small and young dogs by the intravenous route, the following technique should be used in every case:

1. inject atropine sulphate intramuscularly at the rate of 0.05 mg/kg
2. inject acepromazine maleate at the rate of 0.1 mg/kg intravenously or Promethazine (Phenergan) at the rate of 0.5 mL per 5 kg
3. after a period of 10 minutes, inject the appropriate dose of antivenom SLOWLY.

Directions for Use: To be used by, or under the supervision of a registered veterinary surgeon. Because of the wide variation in biological conditions concerned in each case of tick paralysis presented to the clinician, an identical response to a similar dose rate in each case can not be expected. As a guide, 1.0 mL per kg live weight of AVSL antivenom should be taken as that dose required to to effectively counter stage 3 paralysis produced by one tick in a susceptible animal. In practice, response to a particular dose must be monitored, and the dose adjusted to that response.

Administration: This antivenom may be administered by the intravenous, intramuscular, subcutaneous and intraperitoneal routes. There is a recommended route, however for each species. These routes are set out below.

Route of injection in dogs- as the object is using antivenom to neutralise the total amount of toxin introduced by the tick as rapidly as possible, the intravenous route should be used in all cases.
Route of injection in cats- The intravenous route is that preferred, particularly in severely affected cats. However, an appreciation of both the probability of an anaphylactic reaction from the introduction of an heterologous serum, and the method of countering this reaction is essential. Adrenaline should be available as required.
Route of injection in the calf, foal, lamb and kid- the intravenous route is that preferred. However, as mentioned above, anaphylactic reactions may be encountered.
Route of injection in marsupials, koala, rabbit and guinea pig- The intramuscular route is that preferred in these animals. However, as it may stake 12 hours for 50% 0f the injected antibody to reach the circulation by this route, twice the normal dose should be used, particularly in cases of severe paralysis.

Experience derived from experimentation and the treatment of large numbers of tick paralysis cases indicates that as a routine procedure in all cases of tick paralysis where the use of antivenom is contemplated, at least 1/2 mL of the dose should be injected subcutaneously at the site of attachment of the mouthparts of each tick involved.

General treatment of Tick Paralysis:

STRESS: Stress must be recognised as the major factor leading to deaths in animals, particularly cats, which succumb to tick paralysis. It is essential that acepromazine maleate or comparable tranquilising agent be administered prior to handling any animal exhibiting sigsn of anxiety or stress. The animal should be handled the least amount necessary, reated and placed in a cool, quiet environment where external stimuli are reduced to a minimum.

LARYNGEAL PARESIS: Where there is interference with the swallowing reflex, the animal must be given atropine sulphate, hyoscine bromide or other suitable antisialic at regular intervals in order to reduce salivation. In cases where severe respiratory distress is being caused by obsruction at the larynx, atropine therapy followed by intravenous thiopentone at just sufficient dosage to induce stage 1 anaesthesia will assist in providing a retun to a more normal breathing pattern.
ANTIBIOTIC THERAPY: Animals presenting emesis with laryngeal paresis should always be goven a prophylactic antibiotic cover to counter the development of aspiration pneumonia. Penicillin alone is not considered sufficient antibiotic cover.

EMESIS: A non-respiratory depressant anti-emetic such as prochlorpromazine (Stemetil) should be administered intramuscularly at the rate of 1.5 mg/kg/day in three divided doses.

DEHYDRATION AND FLUID THERAPY: Those cases of tick paralysis which are recumbent for prolonged periods (up to 36 hours) do not generally require fluid administration. Small volumes of warmed water run into the rectum at 8 hour intervals, or small volumes of normal saline administered subcutaneously are of greater value than larger volumes given IV.

HYPERTENSION AND TOXAEMIC SHOCK: In cases of severe shock not responding to conventional therapy, the adreneergic alpha receptor blocking agent phenoxybenzamine (Dibenyline) has been shown to produce significant improvement. This should be used at 8-12 hour intervals, at a dose rate of 1.5 mg/kg mixed with 20 mL normal saline, and given slowly IV. Millophylline-V given at a dose of 0.2 mL/kg deeply IM at the same time can increase the amplitude and forse of cardiac contraction, as well as exerting a central respiratory stimulating effect.

RESPIRATORY DISTRESS: Inactivity in striated musculature produces a metabolic acidosis from the excess production of lactic acid. Repiratory distress also leads to an acidosis because of a ise in the pCO2 in arterial blood. The metabolic acidosis present can be countered by giving 5 mmol/L HCO3/kg live weight/day in divided doses. 4.2% sodium bicarbonate solution contains 500 mmol/L. Respiratory acidosis can also be reduced by intubating the animal after adequate tranquilllisation, then allowing it to breathe atmouspheric air through the CO2 absorbers of a standard anaesthetic machine. Oxygen therapy will lad to a reduction in the metaboolic acidosis by increasing the pO2 in arterial blood. The regulation of the percentage of oxygen in inspired air is most easily achieved by the use of a humidi -type of oxygen cabinet. However a 100% oxygen atmousphere must not be provided for periods in excess of 15 minutes at a time , becuase of the possibility of oxygen toxicity producing irreparable damage within the central nervous system.

Presentation: AVSL Ixodes holocyclus antivenom is supplied to the veterinary profession only. The product is available in single 20 mL vials and 50 mL multidose vials.

Storage: This antivenom should be stored away from light, at a temperature between 2 and 8 degC. It should NOT be frozen. When stored for long periods, a slight pre-beta and beta-lipoprotein deposit may settle in the vial. This does not detract from the efficacy of the product.

Addendum: AVSL product Ixodes holocyclus Antivenom has been used since its introduction for the safe and effective treatment of tick-induced paralysis in all species, particularly in cats. If the "Precautions in administration of AVSL Antivenom" are followed , side effects will be negligible. AVSL Antivenom, dose for dose, will be as effective as any more expensive product available, regardless of "despecification".

 

 

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