AN INTERNAL PARASITE UPDATE
MEAT SHEEP ALLIANCE OF FLORIDA FALL SYMPOSIUM
OCAL A , FLORIDA - OCTOBER 14, 2017
SUSAN SCHOENIAN
Sheep & Goat Specialist
University of Maryland Extension
sschoen@umd.edu - (301) 432-2767 x343
www.wormx.info - www.sheepandgoat.com
https://www.slideshare.net/schoenian
PRESENTATION TOPICS
• American Consortium for Small Ruminant Parasite Control (ACSRPC)
• Parasite overview
• Anthelmintics (dewormers) 101
• Anthelmintic resistance
• Combination treatments
• Copper oxide wire particles
• Nematode trapping fungus
• Fecal egg counting
AMERICAN CONSORTIUM FOR SMALL
RUMINANT PARASITE CONTROL
A group of scientists, veterinarians, and extension specialists devoted to (1) developing
novel methods for sustainable control of gastro-intestinal nematodes in small ruminants
and (2) educating the stakeholders in the small ruminant industry on the most up-to-date
methods and recommendations for control of gastrointestinal nematodes.
WEB SITE
WORMX.INFO OR ACSRPC.ORG
Go-to place for information about internal
parasites.
Not Facebook or Google!
ONLINE FAMACHA© TRAINING
• Two members of consortium are piloting
online FAMACHA© Training.
• Dr. Katherine Petersson, University of Rhode
Island
• Dr. Anne Zajac, Virginia Tech
• You view 2.5 hours of video: Integrated
Parasite Control and Why and How to Do
FAMACHA© scoring.
• You Make a video of yourself demonstrating
your FAMACHA© technique and send to URI.
• Have follow-up with URI, if needed.
• Upon completion receive certificate of
competence and right to purchase
FAMACHA© card(s).
http://web.uri.edu/sheepngoat/famacha/
GASTRO-INTESTINAL PARASITES THAT
AFFECT SMALL RUMINANTS
OVERVIEW
• Gastro-intestinal parasites are the
primary health problem affecting
sheep and goats worldwide.
• GI parasites can be an obstacle to
profitable and sustainable small
ruminant production in many
production systems.
• Small ruminants are more susceptible
to parasites than other farm livestock
• Goats are more susceptible than
sheep.
• Problem is worsened by drug
resistance.
MULTI-CELLULAR
HELMINTHS
1. Nemadodes
Roundworms
Strongyles
2. Cestodes
Flatworms
Tapeworms
3. Trematodes
Flukes
1. Coccidia
2. Giardia
3. Cryptospordia
SINGLE CELL
PROTOZOA
MANY DIFFERENT PARASITES CAN
AFFECT SHEEP AND GOATS.
PRIMARY
1. Haemonchus contortus
Barber pole worm
2. Trichostrongylus spp.
Black scour worm (bankrupt
worm)
3. Teladorsagia (Ostertagia)
Brown stomach worm
1. Cooperia
small intestinal
worm
2. Nematodirus
threadneck worm
3. Oesophagostomu
m
nodule worm
4. Bunostomum
hook worm
SECONDARY
NEMATODES – ROUNDWORMS - STRONGYLES
5. Trichuris ovis
whipworm
6. Strongyloides
threadworms
7. Lungworms
8. Parelaphostrongylus tenuis
Meningeal worm
PRIMARY ROUNDWORMS
• Haemonchus contortus
Barber pole worm
• Trichostrongylus spp.
Black scour worm
• Teladorsagia (Ostertagia)
Brown stomach worm
Eggs look the same; need to hatch larvae in order to differentiate species.
Trichostrongylus/Teladorsagia are often not differentiated even when doing larvae ID.
BARBER POLE WORM
HAEMONCHUS CONTORTUS
• Anemia: blood/protein loss
Low packed cell volume (PCV)
FAMACHA© score 3, 4, or 5
• Sub-mandibular edema
“bottle jaw” swelling under jaw
• Loss of weight and condition
• Scours (diarrhea)
• Weakness
• Anorexia
• Death
• Acute haemonchosis: SUDDEN DEATH
• Hypersensitivity of gut
Damage and inflammation of gut
Diarrhea (scours)
• Loss of weight and condition
Slow growth – poor performance
• Lethargy
• Death (sometimes)
• Additive: usually part of mixed infections
with H. contortus.
“SCOUR WORMS”
TRICHOSTRONGYLES
TELADORSAGIA
CLINICAL SIGNS (SYMPTOMS)
ROUNDWORMS CAN BE
HARD TO CONTROL
• Short, direct life cycles
• No intermediate host
• Ability to engage in hypobiosis
• Barber pole worm is prolific egg layer
• Lambs/kids slow to develop
immunity.
• Compromised immunity of
periparturient female.
• Widespread and growing drug
resistance
COCCIDIA (EIMERIA SPP.)
THE OTHER BIG PARASITE PROBLEM
• Single-cell protozoan parasite.
• More complex life cycle than roundworms.
• Host-specific
• Not all species are pathogenic (harmful).
• Affects lambs/kids mostly before and after
weaning.
• Sheep develop strong and lifetime immunity;
goats probably less so.
• Causes diarrhea, but not always, and general ill-
thrift
• Associated with poor hygiene and
management.
https://attra.ncat.org/attra-
pub/summaries/summary.php?pub=483
PREVENTION
• Good hygiene, nutrition, and
management.
• Coccidiostats in mineral, feed, or water
Need to feed or put in water before risk
period
1. Lasalocid (Bovatec®) - sheep
2. Monensin (Rumensin®) - goats (
horses)
3. Decoquinate (Deccox®) - both
4. Amprolium (Corid®) - ELDU, OTC
• Natural control
• Sericea lespedeza pellets
• Other (?)
• Amprolium (Corid®)- ELDU, OTC
• Sulfa drugs (Di-Methox®) - ELDU, Rx, VFD
Damages lining of small intestines.
Damage can be permanent (“runts”)
TREATMENT
COCCIDIOSIS
WHAT ABOUT TAPEWORMS?
MONIEZIA EXPANSA
• Tapeworms are the only parasite visible in the
feces. Diagnosed by seeing segments in
feces.
• Tapeworms tend to be non-pathogenic; not
harmful, but they’re blamed for a lot, usually
no benefit to treatment (goats?).
• Lambs develop immunity at very young age.
• Tapeworms can cause mild unthriftiness and
digestive disturbances, intestinal blockages
(rare) and affect gut motility, predisposing
lambs to enterotoxemia (occasionally).
• Treat with albendazole (Valbazen®) or
praziquantel (in some horse dewormers,
ELDU)
https://www.wormx.info/tapeworms
WHAT ABOUT MENINGEAL WORM?
PARALAPHOSTRONGYLUS TENIUS
• Parasite of white tail deer.
• Also called deer or brain worm.
• Sheep, goats, alpacas, and llamas are
all abnormal hosts.
• Infection requires an intermediate host,
terrestrial snail or slug.
• Causes various neurological symptoms.
• No diagnostic test in live animal.
• No FDA-approved or proven
treatment.
• Cornell University has been evaluating
treatment protocols: fenbendazole
(SafeGuard®) + anti-inflammatory drugs
(Dexamethasone or Banamine).
https://nydairyadmin.cce.cornell.
edu/uploads/doc_392.pdf
ANTHELMINTICS (DEWORMERS) 101
WHAT IS AN ANTHELMINTIC?
• Compounds used to kill gastro-intestinal
parasites without harming host.
• More commonly called wormers, dewormers or
drenches.
• Most anthelmintics have a wide margin of
safety.
• Anthelmintics have different chemistries.
• Chemistry determines which worms they are
effective against, mode of action, and
withdrawal period(s).
• Anthelmintics are grouped by chemistries.
THERE ARE THREE (SORT OF 4) “CHEMICAL” CLASSES
OF DEWORMERS FOR SMALL RUMINANTS (IN THE
US).
GROUP 1
Benzimidazoles
(BZ)
GROUP 2
Macrocylic lactones (ML)
GROUP 3
Nicotinic agonists
Avermectins Milbemycins Imidazo-thiazoles Tetrahydro-pyrimidines
Fenbendazole
SafeGuard®
Panacur®
Ivermectin
Ivomec®
Moxidectin
Cydectin®
Quest®
Levamisole
Prohibit®
Leva-Med®
Tramisol®
Levasol®
Morantel tartrate
Rumatel®
Albendazole
Valbazen®
Doramectin
Dectomax®
Pyrantel
Strongid®
Eprinomectin
Eprinex®
Oxfendazole
Synanthic®
ANTHELMINTICS FDA-APPROVED FOR SHEEP
1
Benzimidazoles
Valbazen®
sheep drench
2a
Avermectins
Ivomec®
sheep drench
2b
Milbimycins
Cydectin®
sheep drench
3
Levamisole
Prohibit®
Leva-Med®
Adult worms    
Larvae (L4)    Limited
Hypobiotic larvae    Limited
Lungworms    
Tapeworms 
Liver flukes Adult stage
Coccidia
External parasites
Some
labeled for bot control
Some
Not labeled
Persistent activity  
Safety
10x
pregnancy restriction
(first 30 days)
20x 5x 3x
Labeled Dosage 3 ml/100 lbs. 3 ml/26 lbs. 1 ml/11 lbs.
Depends on dilution
2 ml/50 lbs
(concentrated drench)
Meat withdrawal 7 days 11 days 7 days 3 days
ANTHELMINTICS FDA-APPROVED FOR GOATS
1
Benzimidazoles
3b
Morantel
Fenbendazole
SafeGuard®
Albendazole
Valbazen®
Feed premix
Rumatel
Adult worms  Not approved 
Larvae (L4)  Not approved sporadic
Hypobiotic larvae  Not approved
Lungworms  Not approved
Tapeworms  Not approved
Liver flukes Adult stage
Coccidia
External parasites
Persistent activity
Safety wide 10x (sheep)
pregnancy restriction
~20x (sheep)
Dosage 1.2 ml/50 lbs. 4 ml/100 lbs. Varies by product
Meat withdrawal 6 days 7 days 30 days
Milk withdrawal 0 days
EXTRA-LABEL ANTHELMINTICS FOR GOATS
1
Benzimidazoles
2a
Avermectins
Ivomec®
sheep drench
2b
Milbimycins
Moxidectin
Cydectin® sheep drench
3a
Levamisole
Prohibit®
Leva-Med®
Fenbendazole
SafeGuard®
Albendazole
Valbazen®
Adult worms     
Larvae (L4)     Limited
Hypobiotic larvae     Limited
Lungworms     
Tapeworms  
Liver flukes Adult stage
Coccidia
External parasites Some
label for bot control
Some
Not labeled
Persistent activity  
Safety wide 10x
pregnancy
restriction
20x 5x 3x
Dosage 1.1 ml/25 lbs. 2 ml/25 lbs. 6 ml/25 lbs. 4.5 ml/25 lbs. Depends on
dilution
Meat withdrawal 16 days
(1 day for each additional day used)
9 days 14 days 17 days 4 days
Milk withdrawal 4 days
(1 day for each additional day used)
7 days 9 days 8 days 3 days
ANTHELMINTIC
RESISTANCE
https://www.wormx.info/anthelmintic-
resistance
IN WORM
• Worms develop resistance to drugs.
Can’t be killed!
Pass resistant genes onto next
generation.
• Some animals are more resistant to
parasites.
Ability to reduce parasite establishment.
Pass resistance genes onto next
generation.
IN ANIMAL
TWO KINDS OF RESISTANCE WHEN WE TALK
ABOUT INTERNAL PARASITES
WHAT IS ANTHELMINTIC RESISTANCE?
• Genetic ability of a worm to survive a dose
of anthelmintic which would normally be
effective.
• Only worms that survive treatment carry
genes that confer resistance.
• Result of selection through exposure of
worm population to an anthelmintic.
• When more than 5 percent of worms are
“drug tolerant”; i.e. failure to reduce FEC by
95% or more (some say 90%).
http://www.scops.org.uk/what-is-resistance.html
ANTHELMINTIC RESISTANCE
• In the US, worms have developed resistance to
all dewormers and dewormer classes, though it
varies by geographic region and farm.
• Worse in Southeast due to increased parasite risk
and need for deworming.
• Worse on farms that frequently deworm or use
improper deworming practices.
• Most farms have resistance to at least two
dewormers; some farms have resistance to all
dewormers/classes. 0
20
40
60
80
100
Benzimidazoles Ivermectin Levamisole Moxidectin
Maryland Virginia Georgia
0
2
4
6
8
10
Susceptible Suspected
resistance
Low
resistance
Moderate
resistance
High
resistance
Full resistance
Number of farms (n=29) resistant to
Benzimidazoles based on DrenchRite® tests
Maryland Virginia
0
1
2
3
4
5
6
7
Susceptible Suspected
resistance
Low resistance Moderate to high High to full
resistance
Number of farms (n=29) resistant to Ivermectin
based on DrenchRite® tests
Maryland Virginia Georgia
0
1
2
3
4
5
6
7
Susceptible Low resistance Low to moderate Moderate to high
Number of farms (n=29) resistant to
Moxidectin based on DrenchRite® tests
Maryland Virginia Georgia
0
1
2
3
4
5
6
7
8
9
Susceptible Suspected
resistance
Low resistance Moderate
resistance
High to full
resistance
Number of farms (n=29) resistant to
Levamisole based on DrenchRite® tests
Maryland Virginia Georgia
ANTHELMINTIC RESISTANCE IS
INEVITABLE, BUT CAN BE DELAYED.
Practices that accelerate development of resistant worms
1. Frequent deworming
2. Whole flock treatments
3. Calendar based treatments
4. Treat and move strategy
5. Rotating dewormers
6. Underdosing
7. Depositing drug in mouth instead of deep into oral cavity.
8. Use of persistent activity dewormers
9. Use injectable dewormers
10. Use pour-on dewormers.
11. Use of feed dewormers*
12. Improper storage of dewormers
FECAL EGG COUNT
REDUCTION TEST
• Compare before and after fecal egg counts
from same animals.
• Old protocol compared post-treatment FECs
of treated animals vs. control (untreated)
group.
• ~15 animals per drug tested
• Minimum FEC of 250 epg*, preferably higher.
• Can use individual or pooled (composite)
samples.
• Cost varies. Can learn to do yourself or send
to parasitology lab.
• Labor-intensive laboratory test that
determines resistance to all dewormers
and classes from a single pooled fecal
sample (from ~10 animals).
• Minimum FEC of 500 epg.
• Also identifies larvae: % Haemonchus
Trichostrongyles eggs look the same.
• Test done exclusively by Dr. Ray Kaplan’s
lab at the University of Georgia.
• $450 per sample
DRENCHRITE® TEST
TWO WAYS TO TEST FOR
ANTHELMINTIC RESISTANCE
Animal Before After % FECR
1 1000 100 90%
2 500 25 95%
3 6000 150 98%
4 4350 250 94%
5 3000 1000 67%
6 1200 400 67%
7 1500 200 87%
8 750 50 93%
9 1100 100 91%
10 3100 200 94%
11 2900 200 93%
12 475 200 58%
13 900 100 89%
14 1100 50 95%
15 300 0 100%
Avg 1878 145 87%
Fecal egg count reduction test (FECRT)
COMBINATION
TREATMENTS
Different drugs to kills same parasites.
Not different drugs for different parasites.
“ THERE NOW IS VERY STRONG EVIDENCE
THAT USING COMBINATION TREATMENT IS
THE BEST METHOD FOR USING
DEWORMERS AND SHOULD BE INSTITUTED
ON ALL FARMS IMMEDIATELY.”
DR. RAY KAPLAN, UNIVERSITY OF GEORGIA (JANUARY
2017)
http://www.wormx.info/combinations
RATIONALE FOR
COMBINATION TREATMENTS
• Most farms have resistance to at
least two of the three major groups
of dewormers; some have resistance
to all.
• At first introduction, drug efficacy is over
99%.
• Once efficacy falls below 95%, drug
resistance is present, though drug is still
useful for treatment.
• As effectiveness of dewormer decreases
(<95%), as it is used more, it provides less
and less benefit to animals.
• Below 50%, it is no longer effective as sole
There is already resistance to Zolvix® in
other countries. Zolvix® is not sold in US.
WHY GIVE COMBINATION
TREATMENTS?
• Contrary to popular belief, rotating between
dewormers will not prevent resistance from
developing. In fact, it will allow worms to
develop resistance to multiple drugs
simultaneously. It is no longer recommended.
• Research done in New Zealand has shown that
the best approach is to use several different
dewormers at one time as a combination
treatment.
• When combined with “best management
practices” (that help to maintain refugia),
combination treatments may improve drug
efficacy and result in a reversion back toward
susceptibility.
Most dewormers sold in New Zealand and Australia
are combination products (multiple drug actives in
same product); combination products are not
available in US.
HOW DO COMBINATIONS WORK?
• Unlike rotating drugs, there is an
additive effect with each drug used
in a combination treatment.
• By achieving a higher efficacy,
there are fewer resistant worms
that survive treatment.
• The sooner you start using
combination treatments the better,
as you achieve the greatest
difference in the percentage of
resistant survivors when efficacy of
dewormers is high.
Drug 1 Drug 2 Drug 3 Combo12 Combo123
80% 80% 80% 96.00% 99.20%
90% 90% 90% 99.00% 99.90%
60% 95% 98.00% 98.00%
60% 60% 95% 84.00% 99.20%
99% 99% 99.99% 99.99%
60% 60% 60% 84.00% 93.60%
50% 50% 50% 75.00% 87.50%
40% 40% 40% 64.00% 78.40%
95% 80% 20% 99.00% 99.20%
RECOMMENDATIONS FOR USING
COMBINATION TREATMENTS
• Purchase and administer each dewormer separately in a
separate syringe.
• Do not mix dewormers. They are not chemically
compatible. Only veterinarians have the right to
compound medications.
• Administer each dewormer at full dose based on an
accurate weight.
• Can give one drug immediately after the other.
• Observe withdrawal period of drug with longest
withdrawal period
RECOMMENDATIONS FOR USING DEWORMERS
IN COMBINATION
Valbazen® Cydectin® Prohibit®*
Sheep 1.5 ml/50 lbs.
[7 days]
4.5 ml/50 lbs.
[7 days]
Depends on dilution
[3 days]
Goats 4 ml/50 lbs.
[9 days meat]
[7 days milk]
9 ml/50 lbs.
[17 days meat]
[8 days milk]
Depends on dilution
[4 days meat]
[3 days milk]
SELECTIVE TREATMENT IS IMPORTANT.
REFUGIA MUST BE MAINTAINED!
• Do not give combination treatments to
all animals in a flock or group.
• Selectively treat clinically-parasitized
animals to maintain refugia.
• Refugia are worms that have not been
exposed to drug.
• Use FAMACHA© system, Five Point
Check©, and Happy Factor™ to
determine which animals need
dewormed.
• If you deworm all animals in a flock or
group, you will simultaneously
accelerate resistance to all drugs.
FAMACHA©
• Use color eye
chart to assess
level (1-5) of
anemia and need
for deworming.
• Decision making
tool for blood-
feeding parasites
only: barber pole
worm.
• Examine 5 points on
animal’s body to
determine need for
deworming: 1) eye
(anemia), 2) jaw (bottle
jaw), 3) back (BCS), 4)
tail (dags), and 5) nose
(nasal bots) or coat (for
goats).
• Expands decision
making abililty to
include parasites other
than blood feeders,
e.g. scour worms.
FIVE POINT CHECK©
DECISION MAKING TOOLS FOR
MAKING DEWORMING DECISIONS
• Use performance,
e.g. ADG, as a
criteria for
making
deworming
decisions.
• Could also use
milk production.
• Untested for
barber pole
worm.
HAPPY FACTOR™
COPPER OXIDE WIRE
PARTICLES (COWPS)
https://www.wormx.info/copper-oxide-wire-
particles
WHAT ARE COPPER OXIDE WIRE
PARTICLES (COWPS)?
• Tiny metal rods of copper oxide
(Cu2O).
• Poorly absorbed, slow release form of
copper versus copper sulfate which is
very absorbable; therefore, greater
potential for toxicity (especially in
sheep).
• Has been shown to reduce barber
pole worm infections in sheep and
goats.
• Available as copper supplement
(different brands) for cattle (12.5 and
25 g) and goats (2 and 4 g).
https://www.wormx.info/copper-oxide-wire-particles
COPPER BASICS
• Sheep and goats require copper in
their diets.
• Copper metabolism is very
complicated, with several antagonists
(interactions), including molybdenum,
sulfur, zinc, cadmium, and iron.
• Copper absorption is more important
than copper concentration in diet.
• Copper absorption rates vary from
90% in young animals to 10% in mature
animals to less than 1% in the presence
of antagonists.
COPPER REQUIREMENTS
• Sheep: old copper requirements were 7-11 ppm
(mg/kg), or 1-8.6 ppm, depending upon
physiological state of animal [NRC, 1985]
• New requirements use factorial method (equation)
to determine copper requirements [NRC, 2007];
equation considers absorption coefficients,
antagonists (Mo, S, Fe, Cd, Zn), and interactions.
• Same data is not available for goats; requirements
are set at 15, 20, and 25 ppm for lactating,
mature, and growing goats respectively;
maximum tolerable amount is unknown.
• Goats have higher copper requirements than
sheep and are less susceptible to copper toxicity.
ASSESS THE COPPER
STATUS OF YOUR
FLOCK/HERD
• Sheep are highly susceptible to copper
toxicity; narrow margin between
requirement and excess; are your goats
copper deficient?
• Blood copper levels can be misleading
• Excess copper accumulates in liver.
• Collect liver and kidney samples for
testing.
• Frozen or chilled samples can be sent to
Michigan State University for testing.
https://www.animalhealth.msu.edu/
TIPS FOR USING COWPS
AS A DEWORMER
• Re-package cattle boluses into
smaller doses for sheep, 0.5 or 1 g.
• Goat boluses can also be
repackaged.
• Use the smallest dose needed to
achieve effect.
• Dose based on age not weight:
mature vs. young.
• Selectively treat animals showing
clinical signs of Haemonchosis
(FAMACHA© 4 or 5)
https://www.wormx.info/cowp-safety
ANOTHER COMBINATION TREATMENT
VALBAZEN® + COWPs
Treatment
(10-23 lambs per Tx group)
Efficacy
(%FECR)
No treatment (control) Increase
Valbazen® (3 ml/50 lbs.) 20%
COWP (2 g, Ultracruz™) 58%
COWP (2 g, Copasure®) 12%
Valbazen® + COWP 99%
Similar results could be expected if
COWPs were combined with other
dewormers (e.g. Prohibit®).
USDA-ARS, Booneville, Arkansas
http://www.wormx.info/cowpcombo
THE FUNGUS MAY SOON
BE AMONG US.
NEMATODE TRAPPING FUNGUS
DUDDINGTONIA FLAGRANS
• Duddingtonia flagrans is a
nematophagous fungus, meaning that it
traps, paralyzes, and consumes parasites.
• Non-chemical, biological control of the
free-living stage of nematode parasites.
• Substantially reduces number of infective
worm larvae, including multi-resistant
larvae.
• Is fed to grazing animals. Spores resist
digestion. No effect on host animal.
Passes through into manure.
• Reduces amount of reinfection from
contaminated pasture. Interrupts of life
cycle.
www.duddingtonia.co
m
USING FUNGUS TO CONTROL PARASITES
• Not commercially available. Not yet.
• Dr. Jim Miller from Louisiana State
University (retired) has been told that
product (fungus) should be available
sometime early 2018.
• Will need to feed every day to maintain
effect.
• Cost may be issue.
• Greatest application is probably zoo
animals.
FECAL EGG COUNTING
www.wormx.info
[Consortium]
[W4: 2015 Conference]
[Fecal egg counts: uses and limitations]
QUALITATIVE
• Positive or negative. Yes or no. - or +
• Mix feces with flotation solution.
Place cover slip on meniscus. Put on
slide.
• Estimates number of eggs in a fresh sample
of manure: eggs per gram of feces (EPG).
• Mix known amount of feces (2-4 g) with
known amount of flotation solution (26-28
ml)
• Fill chambers of McMaster slide
QUANTITATIVE
FECAL EGG COUNTS (FECS)
• You can learn to do your own
fecals or send sample to a
parasitology lab.
• Microscope (100x)
Mechanical stage helpful
• McMaster egg counting slide
• Homemade flotation solution
THREE PRIMARY USES OF
FECAL EGG COUNTS
1. Determine treatment efficacy by comparing before and
after fecal egg counts from a group of animals (~n=15)
• Determine drug resistance on your farm
• Determine efficacy of alternative treatment(s)
2. Monitor pasture contamination
• How fast is pasture contamination building up?
• Determine when to move animals
3. Identify resistant and susceptible animals
• Differentiate between resistance and resilience
• Need sufficient parasite challenge to get data separation (at
least 500 epg group average, 1000 epg better)
By themselves,
fecal egg
counts are not
a good
diagnostic tool
for making
individual
deworming
decisions.
S USAN S CHOENIAN
S H E E P & G OAT S P E C I A L I S T
U N I V E R S I T Y O F M A R Y L A N D E X T E N S I O N
S S C H O E N @ U M D. E D U – ( 3 0 1 ) 4 3 2 - 2 7 6 7 X 3 4 3
S H E E PA N D G OAT. CO M – W O R M X . I N F O
Thank you for your
attention.
Questions?
Comments?
https://www.slideshare.net/schoenian

Internal Parasites Update

  • 1.
    AN INTERNAL PARASITEUPDATE MEAT SHEEP ALLIANCE OF FLORIDA FALL SYMPOSIUM OCAL A , FLORIDA - OCTOBER 14, 2017 SUSAN SCHOENIAN Sheep & Goat Specialist University of Maryland Extension sschoen@umd.edu - (301) 432-2767 x343 www.wormx.info - www.sheepandgoat.com https://www.slideshare.net/schoenian
  • 2.
    PRESENTATION TOPICS • AmericanConsortium for Small Ruminant Parasite Control (ACSRPC) • Parasite overview • Anthelmintics (dewormers) 101 • Anthelmintic resistance • Combination treatments • Copper oxide wire particles • Nematode trapping fungus • Fecal egg counting
  • 3.
    AMERICAN CONSORTIUM FORSMALL RUMINANT PARASITE CONTROL A group of scientists, veterinarians, and extension specialists devoted to (1) developing novel methods for sustainable control of gastro-intestinal nematodes in small ruminants and (2) educating the stakeholders in the small ruminant industry on the most up-to-date methods and recommendations for control of gastrointestinal nematodes.
  • 4.
    WEB SITE WORMX.INFO ORACSRPC.ORG Go-to place for information about internal parasites. Not Facebook or Google!
  • 5.
    ONLINE FAMACHA© TRAINING •Two members of consortium are piloting online FAMACHA© Training. • Dr. Katherine Petersson, University of Rhode Island • Dr. Anne Zajac, Virginia Tech • You view 2.5 hours of video: Integrated Parasite Control and Why and How to Do FAMACHA© scoring. • You Make a video of yourself demonstrating your FAMACHA© technique and send to URI. • Have follow-up with URI, if needed. • Upon completion receive certificate of competence and right to purchase FAMACHA© card(s). http://web.uri.edu/sheepngoat/famacha/
  • 6.
  • 7.
    OVERVIEW • Gastro-intestinal parasitesare the primary health problem affecting sheep and goats worldwide. • GI parasites can be an obstacle to profitable and sustainable small ruminant production in many production systems. • Small ruminants are more susceptible to parasites than other farm livestock • Goats are more susceptible than sheep. • Problem is worsened by drug resistance.
  • 8.
    MULTI-CELLULAR HELMINTHS 1. Nemadodes Roundworms Strongyles 2. Cestodes Flatworms Tapeworms 3.Trematodes Flukes 1. Coccidia 2. Giardia 3. Cryptospordia SINGLE CELL PROTOZOA MANY DIFFERENT PARASITES CAN AFFECT SHEEP AND GOATS.
  • 9.
    PRIMARY 1. Haemonchus contortus Barberpole worm 2. Trichostrongylus spp. Black scour worm (bankrupt worm) 3. Teladorsagia (Ostertagia) Brown stomach worm 1. Cooperia small intestinal worm 2. Nematodirus threadneck worm 3. Oesophagostomu m nodule worm 4. Bunostomum hook worm SECONDARY NEMATODES – ROUNDWORMS - STRONGYLES 5. Trichuris ovis whipworm 6. Strongyloides threadworms 7. Lungworms 8. Parelaphostrongylus tenuis Meningeal worm
  • 10.
    PRIMARY ROUNDWORMS • Haemonchuscontortus Barber pole worm • Trichostrongylus spp. Black scour worm • Teladorsagia (Ostertagia) Brown stomach worm Eggs look the same; need to hatch larvae in order to differentiate species. Trichostrongylus/Teladorsagia are often not differentiated even when doing larvae ID.
  • 11.
    BARBER POLE WORM HAEMONCHUSCONTORTUS • Anemia: blood/protein loss Low packed cell volume (PCV) FAMACHA© score 3, 4, or 5 • Sub-mandibular edema “bottle jaw” swelling under jaw • Loss of weight and condition • Scours (diarrhea) • Weakness • Anorexia • Death • Acute haemonchosis: SUDDEN DEATH • Hypersensitivity of gut Damage and inflammation of gut Diarrhea (scours) • Loss of weight and condition Slow growth – poor performance • Lethargy • Death (sometimes) • Additive: usually part of mixed infections with H. contortus. “SCOUR WORMS” TRICHOSTRONGYLES TELADORSAGIA CLINICAL SIGNS (SYMPTOMS)
  • 12.
    ROUNDWORMS CAN BE HARDTO CONTROL • Short, direct life cycles • No intermediate host • Ability to engage in hypobiosis • Barber pole worm is prolific egg layer • Lambs/kids slow to develop immunity. • Compromised immunity of periparturient female. • Widespread and growing drug resistance
  • 13.
    COCCIDIA (EIMERIA SPP.) THEOTHER BIG PARASITE PROBLEM • Single-cell protozoan parasite. • More complex life cycle than roundworms. • Host-specific • Not all species are pathogenic (harmful). • Affects lambs/kids mostly before and after weaning. • Sheep develop strong and lifetime immunity; goats probably less so. • Causes diarrhea, but not always, and general ill- thrift • Associated with poor hygiene and management. https://attra.ncat.org/attra- pub/summaries/summary.php?pub=483
  • 14.
    PREVENTION • Good hygiene,nutrition, and management. • Coccidiostats in mineral, feed, or water Need to feed or put in water before risk period 1. Lasalocid (Bovatec®) - sheep 2. Monensin (Rumensin®) - goats ( horses) 3. Decoquinate (Deccox®) - both 4. Amprolium (Corid®) - ELDU, OTC • Natural control • Sericea lespedeza pellets • Other (?) • Amprolium (Corid®)- ELDU, OTC • Sulfa drugs (Di-Methox®) - ELDU, Rx, VFD Damages lining of small intestines. Damage can be permanent (“runts”) TREATMENT COCCIDIOSIS
  • 15.
    WHAT ABOUT TAPEWORMS? MONIEZIAEXPANSA • Tapeworms are the only parasite visible in the feces. Diagnosed by seeing segments in feces. • Tapeworms tend to be non-pathogenic; not harmful, but they’re blamed for a lot, usually no benefit to treatment (goats?). • Lambs develop immunity at very young age. • Tapeworms can cause mild unthriftiness and digestive disturbances, intestinal blockages (rare) and affect gut motility, predisposing lambs to enterotoxemia (occasionally). • Treat with albendazole (Valbazen®) or praziquantel (in some horse dewormers, ELDU) https://www.wormx.info/tapeworms
  • 16.
    WHAT ABOUT MENINGEALWORM? PARALAPHOSTRONGYLUS TENIUS • Parasite of white tail deer. • Also called deer or brain worm. • Sheep, goats, alpacas, and llamas are all abnormal hosts. • Infection requires an intermediate host, terrestrial snail or slug. • Causes various neurological symptoms. • No diagnostic test in live animal. • No FDA-approved or proven treatment. • Cornell University has been evaluating treatment protocols: fenbendazole (SafeGuard®) + anti-inflammatory drugs (Dexamethasone or Banamine). https://nydairyadmin.cce.cornell. edu/uploads/doc_392.pdf
  • 17.
  • 18.
    WHAT IS ANANTHELMINTIC? • Compounds used to kill gastro-intestinal parasites without harming host. • More commonly called wormers, dewormers or drenches. • Most anthelmintics have a wide margin of safety. • Anthelmintics have different chemistries. • Chemistry determines which worms they are effective against, mode of action, and withdrawal period(s). • Anthelmintics are grouped by chemistries.
  • 19.
    THERE ARE THREE(SORT OF 4) “CHEMICAL” CLASSES OF DEWORMERS FOR SMALL RUMINANTS (IN THE US). GROUP 1 Benzimidazoles (BZ) GROUP 2 Macrocylic lactones (ML) GROUP 3 Nicotinic agonists Avermectins Milbemycins Imidazo-thiazoles Tetrahydro-pyrimidines Fenbendazole SafeGuard® Panacur® Ivermectin Ivomec® Moxidectin Cydectin® Quest® Levamisole Prohibit® Leva-Med® Tramisol® Levasol® Morantel tartrate Rumatel® Albendazole Valbazen® Doramectin Dectomax® Pyrantel Strongid® Eprinomectin Eprinex® Oxfendazole Synanthic®
  • 20.
    ANTHELMINTICS FDA-APPROVED FORSHEEP 1 Benzimidazoles Valbazen® sheep drench 2a Avermectins Ivomec® sheep drench 2b Milbimycins Cydectin® sheep drench 3 Levamisole Prohibit® Leva-Med® Adult worms     Larvae (L4)    Limited Hypobiotic larvae    Limited Lungworms     Tapeworms  Liver flukes Adult stage Coccidia External parasites Some labeled for bot control Some Not labeled Persistent activity   Safety 10x pregnancy restriction (first 30 days) 20x 5x 3x Labeled Dosage 3 ml/100 lbs. 3 ml/26 lbs. 1 ml/11 lbs. Depends on dilution 2 ml/50 lbs (concentrated drench) Meat withdrawal 7 days 11 days 7 days 3 days
  • 21.
    ANTHELMINTICS FDA-APPROVED FORGOATS 1 Benzimidazoles 3b Morantel Fenbendazole SafeGuard® Albendazole Valbazen® Feed premix Rumatel Adult worms  Not approved  Larvae (L4)  Not approved sporadic Hypobiotic larvae  Not approved Lungworms  Not approved Tapeworms  Not approved Liver flukes Adult stage Coccidia External parasites Persistent activity Safety wide 10x (sheep) pregnancy restriction ~20x (sheep) Dosage 1.2 ml/50 lbs. 4 ml/100 lbs. Varies by product Meat withdrawal 6 days 7 days 30 days Milk withdrawal 0 days
  • 22.
    EXTRA-LABEL ANTHELMINTICS FORGOATS 1 Benzimidazoles 2a Avermectins Ivomec® sheep drench 2b Milbimycins Moxidectin Cydectin® sheep drench 3a Levamisole Prohibit® Leva-Med® Fenbendazole SafeGuard® Albendazole Valbazen® Adult worms      Larvae (L4)     Limited Hypobiotic larvae     Limited Lungworms      Tapeworms   Liver flukes Adult stage Coccidia External parasites Some label for bot control Some Not labeled Persistent activity   Safety wide 10x pregnancy restriction 20x 5x 3x Dosage 1.1 ml/25 lbs. 2 ml/25 lbs. 6 ml/25 lbs. 4.5 ml/25 lbs. Depends on dilution Meat withdrawal 16 days (1 day for each additional day used) 9 days 14 days 17 days 4 days Milk withdrawal 4 days (1 day for each additional day used) 7 days 9 days 8 days 3 days
  • 23.
  • 24.
    IN WORM • Wormsdevelop resistance to drugs. Can’t be killed! Pass resistant genes onto next generation. • Some animals are more resistant to parasites. Ability to reduce parasite establishment. Pass resistance genes onto next generation. IN ANIMAL TWO KINDS OF RESISTANCE WHEN WE TALK ABOUT INTERNAL PARASITES
  • 25.
    WHAT IS ANTHELMINTICRESISTANCE? • Genetic ability of a worm to survive a dose of anthelmintic which would normally be effective. • Only worms that survive treatment carry genes that confer resistance. • Result of selection through exposure of worm population to an anthelmintic. • When more than 5 percent of worms are “drug tolerant”; i.e. failure to reduce FEC by 95% or more (some say 90%). http://www.scops.org.uk/what-is-resistance.html
  • 26.
    ANTHELMINTIC RESISTANCE • Inthe US, worms have developed resistance to all dewormers and dewormer classes, though it varies by geographic region and farm. • Worse in Southeast due to increased parasite risk and need for deworming. • Worse on farms that frequently deworm or use improper deworming practices. • Most farms have resistance to at least two dewormers; some farms have resistance to all dewormers/classes. 0 20 40 60 80 100 Benzimidazoles Ivermectin Levamisole Moxidectin Maryland Virginia Georgia
  • 27.
    0 2 4 6 8 10 Susceptible Suspected resistance Low resistance Moderate resistance High resistance Full resistance Numberof farms (n=29) resistant to Benzimidazoles based on DrenchRite® tests Maryland Virginia
  • 28.
    0 1 2 3 4 5 6 7 Susceptible Suspected resistance Low resistanceModerate to high High to full resistance Number of farms (n=29) resistant to Ivermectin based on DrenchRite® tests Maryland Virginia Georgia
  • 29.
    0 1 2 3 4 5 6 7 Susceptible Low resistanceLow to moderate Moderate to high Number of farms (n=29) resistant to Moxidectin based on DrenchRite® tests Maryland Virginia Georgia
  • 30.
    0 1 2 3 4 5 6 7 8 9 Susceptible Suspected resistance Low resistanceModerate resistance High to full resistance Number of farms (n=29) resistant to Levamisole based on DrenchRite® tests Maryland Virginia Georgia
  • 31.
    ANTHELMINTIC RESISTANCE IS INEVITABLE,BUT CAN BE DELAYED. Practices that accelerate development of resistant worms 1. Frequent deworming 2. Whole flock treatments 3. Calendar based treatments 4. Treat and move strategy 5. Rotating dewormers 6. Underdosing 7. Depositing drug in mouth instead of deep into oral cavity. 8. Use of persistent activity dewormers 9. Use injectable dewormers 10. Use pour-on dewormers. 11. Use of feed dewormers* 12. Improper storage of dewormers
  • 32.
    FECAL EGG COUNT REDUCTIONTEST • Compare before and after fecal egg counts from same animals. • Old protocol compared post-treatment FECs of treated animals vs. control (untreated) group. • ~15 animals per drug tested • Minimum FEC of 250 epg*, preferably higher. • Can use individual or pooled (composite) samples. • Cost varies. Can learn to do yourself or send to parasitology lab. • Labor-intensive laboratory test that determines resistance to all dewormers and classes from a single pooled fecal sample (from ~10 animals). • Minimum FEC of 500 epg. • Also identifies larvae: % Haemonchus Trichostrongyles eggs look the same. • Test done exclusively by Dr. Ray Kaplan’s lab at the University of Georgia. • $450 per sample DRENCHRITE® TEST TWO WAYS TO TEST FOR ANTHELMINTIC RESISTANCE
  • 33.
    Animal Before After% FECR 1 1000 100 90% 2 500 25 95% 3 6000 150 98% 4 4350 250 94% 5 3000 1000 67% 6 1200 400 67% 7 1500 200 87% 8 750 50 93% 9 1100 100 91% 10 3100 200 94% 11 2900 200 93% 12 475 200 58% 13 900 100 89% 14 1100 50 95% 15 300 0 100% Avg 1878 145 87% Fecal egg count reduction test (FECRT)
  • 34.
    COMBINATION TREATMENTS Different drugs tokills same parasites. Not different drugs for different parasites.
  • 35.
    “ THERE NOWIS VERY STRONG EVIDENCE THAT USING COMBINATION TREATMENT IS THE BEST METHOD FOR USING DEWORMERS AND SHOULD BE INSTITUTED ON ALL FARMS IMMEDIATELY.” DR. RAY KAPLAN, UNIVERSITY OF GEORGIA (JANUARY 2017) http://www.wormx.info/combinations
  • 36.
    RATIONALE FOR COMBINATION TREATMENTS •Most farms have resistance to at least two of the three major groups of dewormers; some have resistance to all. • At first introduction, drug efficacy is over 99%. • Once efficacy falls below 95%, drug resistance is present, though drug is still useful for treatment. • As effectiveness of dewormer decreases (<95%), as it is used more, it provides less and less benefit to animals. • Below 50%, it is no longer effective as sole There is already resistance to Zolvix® in other countries. Zolvix® is not sold in US.
  • 37.
    WHY GIVE COMBINATION TREATMENTS? •Contrary to popular belief, rotating between dewormers will not prevent resistance from developing. In fact, it will allow worms to develop resistance to multiple drugs simultaneously. It is no longer recommended. • Research done in New Zealand has shown that the best approach is to use several different dewormers at one time as a combination treatment. • When combined with “best management practices” (that help to maintain refugia), combination treatments may improve drug efficacy and result in a reversion back toward susceptibility. Most dewormers sold in New Zealand and Australia are combination products (multiple drug actives in same product); combination products are not available in US.
  • 38.
    HOW DO COMBINATIONSWORK? • Unlike rotating drugs, there is an additive effect with each drug used in a combination treatment. • By achieving a higher efficacy, there are fewer resistant worms that survive treatment. • The sooner you start using combination treatments the better, as you achieve the greatest difference in the percentage of resistant survivors when efficacy of dewormers is high. Drug 1 Drug 2 Drug 3 Combo12 Combo123 80% 80% 80% 96.00% 99.20% 90% 90% 90% 99.00% 99.90% 60% 95% 98.00% 98.00% 60% 60% 95% 84.00% 99.20% 99% 99% 99.99% 99.99% 60% 60% 60% 84.00% 93.60% 50% 50% 50% 75.00% 87.50% 40% 40% 40% 64.00% 78.40% 95% 80% 20% 99.00% 99.20%
  • 39.
    RECOMMENDATIONS FOR USING COMBINATIONTREATMENTS • Purchase and administer each dewormer separately in a separate syringe. • Do not mix dewormers. They are not chemically compatible. Only veterinarians have the right to compound medications. • Administer each dewormer at full dose based on an accurate weight. • Can give one drug immediately after the other. • Observe withdrawal period of drug with longest withdrawal period
  • 40.
    RECOMMENDATIONS FOR USINGDEWORMERS IN COMBINATION Valbazen® Cydectin® Prohibit®* Sheep 1.5 ml/50 lbs. [7 days] 4.5 ml/50 lbs. [7 days] Depends on dilution [3 days] Goats 4 ml/50 lbs. [9 days meat] [7 days milk] 9 ml/50 lbs. [17 days meat] [8 days milk] Depends on dilution [4 days meat] [3 days milk]
  • 41.
    SELECTIVE TREATMENT ISIMPORTANT. REFUGIA MUST BE MAINTAINED! • Do not give combination treatments to all animals in a flock or group. • Selectively treat clinically-parasitized animals to maintain refugia. • Refugia are worms that have not been exposed to drug. • Use FAMACHA© system, Five Point Check©, and Happy Factor™ to determine which animals need dewormed. • If you deworm all animals in a flock or group, you will simultaneously accelerate resistance to all drugs.
  • 42.
    FAMACHA© • Use coloreye chart to assess level (1-5) of anemia and need for deworming. • Decision making tool for blood- feeding parasites only: barber pole worm. • Examine 5 points on animal’s body to determine need for deworming: 1) eye (anemia), 2) jaw (bottle jaw), 3) back (BCS), 4) tail (dags), and 5) nose (nasal bots) or coat (for goats). • Expands decision making abililty to include parasites other than blood feeders, e.g. scour worms. FIVE POINT CHECK© DECISION MAKING TOOLS FOR MAKING DEWORMING DECISIONS • Use performance, e.g. ADG, as a criteria for making deworming decisions. • Could also use milk production. • Untested for barber pole worm. HAPPY FACTOR™
  • 43.
    COPPER OXIDE WIRE PARTICLES(COWPS) https://www.wormx.info/copper-oxide-wire- particles
  • 44.
    WHAT ARE COPPEROXIDE WIRE PARTICLES (COWPS)? • Tiny metal rods of copper oxide (Cu2O). • Poorly absorbed, slow release form of copper versus copper sulfate which is very absorbable; therefore, greater potential for toxicity (especially in sheep). • Has been shown to reduce barber pole worm infections in sheep and goats. • Available as copper supplement (different brands) for cattle (12.5 and 25 g) and goats (2 and 4 g). https://www.wormx.info/copper-oxide-wire-particles
  • 45.
    COPPER BASICS • Sheepand goats require copper in their diets. • Copper metabolism is very complicated, with several antagonists (interactions), including molybdenum, sulfur, zinc, cadmium, and iron. • Copper absorption is more important than copper concentration in diet. • Copper absorption rates vary from 90% in young animals to 10% in mature animals to less than 1% in the presence of antagonists.
  • 46.
    COPPER REQUIREMENTS • Sheep:old copper requirements were 7-11 ppm (mg/kg), or 1-8.6 ppm, depending upon physiological state of animal [NRC, 1985] • New requirements use factorial method (equation) to determine copper requirements [NRC, 2007]; equation considers absorption coefficients, antagonists (Mo, S, Fe, Cd, Zn), and interactions. • Same data is not available for goats; requirements are set at 15, 20, and 25 ppm for lactating, mature, and growing goats respectively; maximum tolerable amount is unknown. • Goats have higher copper requirements than sheep and are less susceptible to copper toxicity.
  • 47.
    ASSESS THE COPPER STATUSOF YOUR FLOCK/HERD • Sheep are highly susceptible to copper toxicity; narrow margin between requirement and excess; are your goats copper deficient? • Blood copper levels can be misleading • Excess copper accumulates in liver. • Collect liver and kidney samples for testing. • Frozen or chilled samples can be sent to Michigan State University for testing. https://www.animalhealth.msu.edu/
  • 48.
    TIPS FOR USINGCOWPS AS A DEWORMER • Re-package cattle boluses into smaller doses for sheep, 0.5 or 1 g. • Goat boluses can also be repackaged. • Use the smallest dose needed to achieve effect. • Dose based on age not weight: mature vs. young. • Selectively treat animals showing clinical signs of Haemonchosis (FAMACHA© 4 or 5) https://www.wormx.info/cowp-safety
  • 49.
    ANOTHER COMBINATION TREATMENT VALBAZEN®+ COWPs Treatment (10-23 lambs per Tx group) Efficacy (%FECR) No treatment (control) Increase Valbazen® (3 ml/50 lbs.) 20% COWP (2 g, Ultracruz™) 58% COWP (2 g, Copasure®) 12% Valbazen® + COWP 99% Similar results could be expected if COWPs were combined with other dewormers (e.g. Prohibit®). USDA-ARS, Booneville, Arkansas http://www.wormx.info/cowpcombo
  • 50.
    THE FUNGUS MAYSOON BE AMONG US.
  • 51.
    NEMATODE TRAPPING FUNGUS DUDDINGTONIAFLAGRANS • Duddingtonia flagrans is a nematophagous fungus, meaning that it traps, paralyzes, and consumes parasites. • Non-chemical, biological control of the free-living stage of nematode parasites. • Substantially reduces number of infective worm larvae, including multi-resistant larvae. • Is fed to grazing animals. Spores resist digestion. No effect on host animal. Passes through into manure. • Reduces amount of reinfection from contaminated pasture. Interrupts of life cycle. www.duddingtonia.co m
  • 52.
    USING FUNGUS TOCONTROL PARASITES • Not commercially available. Not yet. • Dr. Jim Miller from Louisiana State University (retired) has been told that product (fungus) should be available sometime early 2018. • Will need to feed every day to maintain effect. • Cost may be issue. • Greatest application is probably zoo animals.
  • 53.
    FECAL EGG COUNTING www.wormx.info [Consortium] [W4:2015 Conference] [Fecal egg counts: uses and limitations]
  • 54.
    QUALITATIVE • Positive ornegative. Yes or no. - or + • Mix feces with flotation solution. Place cover slip on meniscus. Put on slide. • Estimates number of eggs in a fresh sample of manure: eggs per gram of feces (EPG). • Mix known amount of feces (2-4 g) with known amount of flotation solution (26-28 ml) • Fill chambers of McMaster slide QUANTITATIVE FECAL EGG COUNTS (FECS) • You can learn to do your own fecals or send sample to a parasitology lab. • Microscope (100x) Mechanical stage helpful • McMaster egg counting slide • Homemade flotation solution
  • 55.
    THREE PRIMARY USESOF FECAL EGG COUNTS 1. Determine treatment efficacy by comparing before and after fecal egg counts from a group of animals (~n=15) • Determine drug resistance on your farm • Determine efficacy of alternative treatment(s) 2. Monitor pasture contamination • How fast is pasture contamination building up? • Determine when to move animals 3. Identify resistant and susceptible animals • Differentiate between resistance and resilience • Need sufficient parasite challenge to get data separation (at least 500 epg group average, 1000 epg better) By themselves, fecal egg counts are not a good diagnostic tool for making individual deworming decisions.
  • 56.
    S USAN SCHOENIAN S H E E P & G OAT S P E C I A L I S T U N I V E R S I T Y O F M A R Y L A N D E X T E N S I O N S S C H O E N @ U M D. E D U – ( 3 0 1 ) 4 3 2 - 2 7 6 7 X 3 4 3 S H E E PA N D G OAT. CO M – W O R M X . I N F O Thank you for your attention. Questions? Comments? https://www.slideshare.net/schoenian