This month, our co-founder, Jess, was shocked when her dog, Stanley, was diagnosed with pneumonia. Jess shared Stanley’s diagnosis on his instagram account and was flooded with questions from our community. To answer those questions, TOC sat down with Dr. Brent Gordon, DVM and Medical Director of Bond Vet Bethesda.

What is kennel cough?

Dr. Gordon: There are a number of reasons for a dog to develop a cough, but a common one is bacteria and viruses that infect the respiratory tract, such as bordetella and canine influenza.

Canine infectious respiratory disease complex, or CIRD for short, is an infectious respiratory disease transmitted between dogs, and in rare instances cats. The most common organisms that contribute to the canine respiratory disease complex include viruses like canine influenza and bacteria like bordetella, which we commonly refer to as kennel cough.

What are some of the symptoms to look for with kennel cough?

Dr. Gordon: Coughing, sneezing, and eye discharge are the main symptoms, but some pets will have lethargy, loss of appetite, coughing up sputum or phlegm, or in rare cases difficulty breathing. Some pets may also have vomiting or diarrhea, but this is less common.

How is kennel cough transmitted? 

Dr. Gordon: It is transmitted through respiratory droplets in the air (think coughing), direct contact with an infected dog, or when they come in contact with a surface or object that another sick pet interacted with.

It is a big issue for areas of high traffic or close proximity such as dog parks, kennels, doggie day care, grooming, and really any event or location that sees lots of animals in a small space.

How does kennel cough or canine flu progress into pneumonia? 

Dr. Gordon: It progresses to pneumonia in the same way that the flu or COVID becomes pneumonia in people. The virus causes inflammation in the lungs and reduces the immune system's ability to respond to other bacteria. Bacteria then take advantage of the situation and pneumonia develops. Pneumonia is just inflammation/infection in the lungs that is caused by a bacteria or virus. 

Canine influenza progressing to pneumonia is still pretty rare and only about 10 - 20% of cases will develop pneumonia.

How would you describe pneumonia or canine flu to someone?

Dr. Gordon: Canine influenza is a virus that is easily transmitted between dogs, which causes coughing, fever, lethargy, loss of appetite and other similar symptoms to the human flu. In most animals it will resolve without issue in a few weeks with supportive care. In a few cases however it can progress to pneumonia, which may be life threatening in rare cases.

So is canine flu kind of like COVID?

Dr. Gordon: You can actually make a lot of parallels between COVID & canine influenza. It's a respiratory disease. It can spread through the air. It's something that we can vaccinate against, but it doesn't provide complete immunity or total immunity. We [can still] get it, but it's a less severe form or we're less likely to have complications. All of that is very, very similar to dogs when it comes to canine influenza. But they are still very different viruses in other ways.

What are some of the symptoms to look for that indicate that your dog’s kennel cough may have progressed to something more serious? 

Dr. Gordon: Generally if your pet is happy, eating, and playful despite the cough, there is likely no major concern. The signs to look for that are a concern are when the cough is severe, they can’t sleep, they are lethargic, don’t want to eat, they are coughing up green or white phlegm or they have difficulty breathing or rapid breathing.

At what point in seeing symptoms do you recommend taking your dog to the vet? 

Dr. Gordon: For any pet owner that has a pet with unexplained coughing I would recommend taking them to the vet or doing a virtual visit at the least. There are a large number of other causes for cough in dogs that may have a worse outcome if undiagnosed. 

Generally speaking a young dog, who recently went to a boarding facility, with no other history of disease, who feels well and has a very mild cough could be monitored at home. But I would still recommend a visit in case there is something a veterinarian may pick up on that is important. For older pets or pets with a known history of heart or lung disease, or pets that have moderate symptoms, or no history of boarding or other dog exposure, it is best to have these pets seen in person, regardless of the severity of their symptoms.

Are dogs who have been vaccinated for Bordetella and canine influenza still able to get kennel cough? 

Dr. Gordon: Yes, dogs that are vaccinated can still get kennel cough or canine influenza. The vaccines for these diseases will provide partial immunity, meaning that they are less likely to have severe symptoms when vaccinated, but it doesn’t prevent them from getting the disease.

It's interesting because our dog Stanley had the Bordetella shot and I believe the flu vaccine and he still developed pneumonia. Is he an anomaly?

Dr. Gordon: No, not really. 10 to 20% of dogs will develop pneumonia after getting canine influenza, and that's just one cause of respiratory disease. There's a whole complex of different diseases out there that can contribute. It's also based on other factors too. It sounds like your dog had gotten the first symptoms or first signs of pneumonia while they boarded. So a dog that is under stress unfortunately is more likely to have a reduced immune system response.

Potentially there's, other complicating factors too. If they are boarded in isolation, that may reduce risk some, but not completely. Some places will have world class immaculate facilities, but then in other cases they may not have accounted for all ways the disease can be transmitted. They may not have adequate ventilation, or the pets are crowded or visit a communal space, share a water bowl, etc. So they could have things at the boarding facility that complicate, or spread the disease. I would always warn owners that if you have a dog who is coughing and is either diagnosed, via a test or presumptively diagnosed based on the doctor's opinion with kennel cough or canine influenza, potentially this dog is infectious to other dogs for up to a month. They should avoid boarding or grooming, but also they can contract another disease while their immune system's reduced. So you always have to be super careful about those things.

Is there anything guardians can do to protect their dogs from getting kennel cough? 

Dr. Gordon: Generally speaking, the best things to do are to have your pets routinely vaccinated, and to avoid areas where dogs congregate or high traffic areas for pets during times when kennel cough or canine influenza may be going around.

For facilities that are looking after dogs that may be able to spread canine influenza or kennel cough it is best for these facilities to screen pets for signs of illness, require vaccinations, have proper ventilation, and disinfect the area routinely.

You can also call facilities and ask if they are seeing outbreaks of kennel cough or similar. It’s better to change your plans in some cases than to risk exposing your pet when it may be unnecessary.

What should I do if I find out that my dog was exposed to kennel cough via daycare, boarding, grooming, etc. but they aren’t showing any symptoms yet? 

Dr. Gordon: The best thing to do is isolate them from other dogs (keep them at home and in the backyard) and monitor them for symptoms for the next 2 weeks. If your dog does not develop symptoms it is unlikely they have contracted the disease and can return to normal.

We've heard this is the worst case of kennel cough in 20 years. Is that true? If so, why do you think that's the case? (Is that just an anecdote or is that data coming from somewhere?)

Dr. Gordon: The current outbreak certainly is the worst in my memory, but I have only been practicing for about 8 years. Other veterinarians who have been practicing for longer may have different opinions as there was a time before vaccines for these diseases were readily available or commonly used.

Do you think that there's any chance that the reason why this is such a prolific period for canine influenza and kennel cough and pneumonia by extension is because dogs were away from each other for a while because of the pandemic and now society is open again and people are out and about? (I've heard people extrapolating like that previously, but I didn't know if that was the case.)

Dr. Gordon: I think there's a number of factors. I'll tell you a couple things that I think are contributing to it, but I don't think the veterinary scientific community will know for sure until this outbreak that's currently happening is well in our rearview mirror and we look back at the data and see who is getting what, where, and can compare the numbers to previous years. You'll see news articles every year around this time about kennel cough outbreaks or canine influenza outbreaks and generally speaking, I do think there's probably a couple factors that could come into place where there's a fair number of new dog owners or people who purchased or adopted dogs during COVID lockdown. Just because we did see a huge spike of ownership, during and following the COVID lockdown, I think a lot of those dogs are now being boarded. I think a lot of those owners are now traveling, whereas say a year ago or even two years ago when it was a lot less likely they would travel. We weren't really having this much of an issue. During and before lockdown, we'd still see kennel cough from people boarding their dogs, and those still going to doggy daycare. But I think there's just so much more boarding and daycare now because I think people are starting to feel more confident with their own travel plans, or they're having to go back to work. So doggy daycare and kennels and boarding facilities are just much more inundated with dogs, and with reduced ventilation during the winter, I think that just increases the likelihood that these types of outbreaks could occur.

Is there any way to support our dogs’ immune systems so that they don't get this or so they recover quickly from it? 

Dr. Gordon: The best thing you can do is vaccinate, and avoid known areas where dogs congregate when an outbreak is occurring.

Otherwise basic things such as feeding a complete and balanced diet, keeping them indoors during cold weather, proper ventilation if other dogs are visiting, cleaning bowls or items other dogs have interacted with, and letting them rest if they seem less active, should be enough to keep your pets immune system in the best shape.

What about taking a daily probiotic?

Dr. Gordon: I'm not aware that there's any studies that have proven that there's some efficacy for probiotics when it comes to canine influenza, kennel cough, or similar respiratory diseases in dogs. I am aware there are some initial trials in laboratory animals and the use of probiotics for influenza-like diseases, but I don’t think there is a broad scientific consensus on this in dogs. I do think that there is a place for probiotics in a number of other diseases, generally GI related diseases, but I think it will be a while longer before we determine a benefit for this specific use.

What is the healing process like for a typical dog that gets kennel cough, dog flu, and pneumonia? 

Dr. Gordon: When talking about canine flu or kennel cough, the most common course of the disease is over the period of 7 - 14 days with a residual cough that may persist for up to a month. They need basic supportive care such as a safe environment, that is climate controlled, with food and water nearby, and plenty of rest. They really should be doing very little in the way of activity as they should not be going out for walks in the neighborhood or dog parks as they could potentially get other dogs infected or pick up another respiratory disease themselves. A little bit of time outside and movement is likely somewhat beneficial, but rest is still a core component to recovery.

For pneumonia it can vary wildly and may include antibiotics and rest at home with the use of a nebulizer to help break up respiratory secretions. Or in very rare cases it may require hospitalization, IV fluids and medications, and oxygen therapy. Recovery from pneumonia may take 1 - 2 months for some patients. Untreated pneumonia can be life threatening. And in some cases even treated pets will still succumb to the disease, but this is rare.

This period has reminded me a lot of when our dog was neutered because they're supposed to rest a lot and you're not really supposed to play with them, which can be very challenging because dogs' needs are not being met. When we were talking to one of your colleagues, they even said not to use a snuffle mat, or have him play outside and to take all his chews away, which is very challenging for our dog. What is your take on that and how to contend with those changes during the recovery period?

Dr. Gordon: For those dogs with uncomplicated kennel cough, I think it’s still reasonable to say you can continue to entertain them and engage in limited activity in small ways in your own home or your backyard depending on how they're doing. The first two weeks are often the most severe in terms of the symptoms and I'd have kid gloves at that point and say to an owner, “okay, let's keep them calm, let's not get them too active, because when they get active, the coughing is worse and it worsens inflammation in the lungs”. This is the phase they need to rest the most. But after they recover and they seem bright and alert with minimal coughing then they're just kind of in the infectious phase where they might be able to transmit the disease but don’t have much of the symptoms. That’s when I would say it's okay to do some light exercise in the backyard, and toss the ball around for short periods, or something similar.

For those dogs that have pneumonia, it's a little bit different. It is a slowly resolving disease. It can take up to a month or more for them to completely resolve. In the case of pneumonia we shoudl be more cautious about activity, do very minimal stuff. It’s beneficial for them to get up and walk around the house or briefly in the backyard. But I don't necessarily think that I would completely remove all objects. I think I would continue with objects that you could easily sterilize after the fact or discard if they can’t be cleaned properly. 

To clean, usually it's going to be something like dilute bleach or similar cleaner. If you have a standard bottle of bleach that you would use on laundry, then you can do a one to ten dilution. So that’s one part bleach, nine parts water and then you bathe the object in it for about five to ten minutes. That is enough contact time for it to kill the virus and reduce the likelihood of reinfection or transmission.

So you would use the bleach if you had another dog coming over to your house and you were worried that they were going to take a ball or something and you didn't want to spread whatever your dog has?

Dr. Gordon: Maybe you have the same water bowl, or toys, or you have the same food bowl from before and the dogs are going to share. You might need to clean these before another dog shows up in the house.

How can we help reduce the spread? 

Dr. Gordon: The best thing is vaccinating your own pets and if your pet has a cough, do not take your pet to dog parks, boarding facilities, kennels, dog shows, the groomers, or for walks in areas of your neighborhood where other dogs may pass by. It can vary based on the pet and the underlying disease, but it is possible for pets to be infectious to other dogs for up to one month, so quarantine your pet away from other pets for 1 month before returning to the groomers or doggie day care.

When you talk about quarantining for up to a month after you develop canine influenza or pneumonia, is that a month from when you first have symptoms?

Dr. Gordon: Generally it's going to be a month from when they first have symptoms, but I would address that per patient. It's really something where if they're still having a lot of ongoing coughing or other symptoms, or they were hospitalized for a period of time and they had to be treated for pneumonia, I might extend that for even longer to eight weeks in some cases. But if we're talking about just the most common form that we see where it's mild symptoms, they generally recover in about two weeks, and I would say an additional two weeks minimum. You'll find different resources that quote differently. Some will say 28 days, some will say six weeks minimum. I think it just kind of depends on the studies they're looking at and the opinion of the veterinarian for that specific case.

Given the current climate, is it safe to get your dog groomed in a mobile grooming vehicle by themselves? 

Dr. Gordon: If the area in the mobile center is cleaned appropriately, if they screen the animals that come in, and if they make sure the animals are vaccinated, I think it reduces the likelihood if they're doing it properly because it just means that they're less likely to directly interact with another dog and they probably see less dogs per day than a grooming facility. So it could reduce the chance your pet would contract a respiratory disease if done properly.

Once you get pneumonia, we heard that it's easy for a dog to contract it again. Is that true just because their immune system has been hit by it? 

Dr. Gordon: I would say any dog that has recently had pneumonia can contract it again because it's such a slowly resolving disease. It can rapidly progress and get worse, but recovery is just very slow. For any dog that's recently had pneumonia, there's probably residual inflammation and changes within the lungs that will make it more difficult to recover should a second disease come along and infect the pet. I would just be really careful with those dogs that have recently had pneumonia and potentially putting them in a situation where they could develop another respiratory condition.

Can dogs spread this to humans? 

Dr. Gordon: For healthy adults it is very unlikely to be transmissible from dogs to people. For those that are immunocompromised it is possible but still rare. People that are immunocompromised (the very young, old, going through chemotherapy or similar), they may need to take extra precautions if their pet is suspected of being sick with pneumonia, kennel cough, or canine influenza.

It is best to have the dog isolated from those that are immunocompromised and the pet handled and cared for by someone who is healthy. If this is not possible then the pet should sleep in a different room, minimal contact needed to feed and let the pet outside, and wash hands thoroughly. It may also be helpful to increase fresh airflow into the house to reduce airborne transmission. If this is a concern for you it is best to speak to your doctor about other precautions based on your specific need.

What about if your dog is diagnosed with canine flu or pneumonia and they're on antibiotics? Is there still a danger of transmission to humans if they're immunocompromised?

Dr. Gordon: Yeah, there is still some danger. Again, it depends on what the diagnosis is and even then transmission is still very rare. As far as I'm aware and as far as my research has shown, there's no reported cases of canine influenza being transmitted to humans, but there's a number of other infectious disease agents that could be transmissible from pets to people. Even though they're on antibiotics, there's still often a viral component to these respiratory diseases that needs to run its course and the antibiotics are not gonna do anything for that component of the disease. So I still would recommend, for the most part, to minimize contact if there's some concern there. But if you're a healthy adult, and you're washing your hands after interacting with the pet, and they're not sleeping on your chest and coughing in your face, then I would say that there's pretty minimal concern there.

Are you still seeing the same volume of cases or has it decreased at all?

Dr. Gordon: It's decreased a little bit. We were seeing about three cases a day of kennel cough or canine influenza a day at our practice and now we're seeing maybe one every other day. There's four doctors that work there and we meet up as a group frequently and everyone agrees it's getting a little bit better.

How many cases of pneumonia have you seen a day?

Dr. Gordon: I have seen at least two recently and I did see a case unfortunately pass away. I hadn't been treating it. They came into us urgently, and the dog immediately collapsed and passed away. But it was suspected of having canine influenza. This is very rare to have happen, but it’s important to know. I think our hospital's probably seen more than that though. In terms of dogs with pneumonia, we've probably seen, if I were to guess at least two or three cases per doctor. So we're looking at closer to around ten cases or maybe a little bit less than that, because we've probably seen about 50 cases of kennel cough and canine influenza in the last few months and that would fit with the nationwide statistics too.