Cevac Chlamydia - NADIS · Cevac® Chlamydia Cevac® Chlamydia 1: EAE – stats and facts 2: What does disease look like? How do I know it’s an infectious cause? How does Chlamydophila

Cevac®

Chlamydia

Cevac® Chlamydia

1: EAE – stats and facts

2: What does disease look like?

How do I know it’s an infectious cause?

How does Chlamydophila abortus cause abortion?

Latent infections

Abortion storms and unvaccinated flocks

3: How disease is spread

4: Impact of disease

Zoonotic Risk

5: Control of disease

Reduction of infection following vaccination

6: Why Cevac Chlamydia?

Vaccine mode of action

Pack sizes

Cevac vaccination kit

Sterimatic needle protector and cleaning system

7: Vaccination points to consider

8: FAQs

9: In the face of an outbreak

10: Relevant clinical paper titles and regulatory information

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Stats and factsCevac®

Chlamydia

1. LONGBOTTOM, 2012 2. MEARNS, 2007

The most frequently diagnosed cause of abortion in UK sheep is enzootic abortion (EAE), caused by the bacteria Chlamydophila abortus

33.8%1

increasing to 47.6% in flocks > 150 animals

Prevalence of EAE in UK flocks:

EAE is estimated to cost the sheep industry over

per annum2£15 million

– Those who have experienced the losses associated with the condition are strongly motivated to prevent it happening again, proving the huge impact that it can have

76.8%of flocks that have experienced EAE now vaccinate against infection only 15% of those farms without a history of infection vaccinate1

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2. MEARNS, 2007

An abortion rate of over 2% is suggestive of an infectious cause and should be investigated

Enzootic abortion causes foetal death in late pregnancy or birth of very weak lambs that rarely survive. Ewes are often well in themselves at the time of abortion

If infection occurs more than 6 weeks from birth, it remains latent and remerges in the subsequent pregnancy (causing abortion or weak lambs)

Abortion often occurs in ‘storms’, with typical abortion rates of 30%2

What does the disease look like?

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Chlamydia1: EAE – stats and facts




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2. MEARNS, 2007

An abortion rate of over 2% is suggestive of an infectious cause and should be investigated

Having the odd abortion is often accepted by shepherds, but if 2-3% of the flock are aborting, or there is an abortion rate of greater than 1% over a couple of days, it is likely that the problem is infectious in origin and is likely to escalate

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Bacteria enters sheep via the ingestion of infected afterbirth and vaginal dischargeBacterium is ingested by sheep as an elementary body (defined as extra-cellular, infectious, metabolically inactive and resistant to external media, such as antibiotics)

The bacteria travels to the placenta, infecting the cells thereChlamydophila abortus has a tropism for ruminants’ placentas - the elementary body is taken into placental cells via endocytosis

1

6-10 hrs

0 hrs

10-24hrs 24-72hrs

Bacteria multiply within the placental cellsThe elementary body converts to a reticulate body (defined as intra-cellular, metabolically active and sensitive to antimicrobials), allowing bacterial multiplication by binary division (the bacteria can only replicate within the cytoplasm of a eukaryote cell in this way)

Escalating inflammation and cell damage interferes with placental function, shutting down the vital support that it offers the unborn lambExtensive cell lysis compromises foetal nutrient uptake, waste elimination, and gas exchange, leading to eventual foetal death or the birth of very weak lambs

The multiplying bacteria cause the cell to burst, releasing more infective bacteria and causing inflammationReticulate bodies convert back to elementary bodies before cell lysis occurs, allowing further surrounding cell infection and eventual extensive tissue damage

When initial infection occurs less than 6 weeks before a ewe’s due date, infection does not reach the placenta and cause damage. Instead, the bacteria remain ’hidden’ and seemingly harmless, until the ewe is next pregnant, when it travels to the placenta and causes abortion via the process explained aboveThe mechanism of this latency seems to include lymphoid tissue, but is currently poorly understood

2 3 4

5

What does the disease look like?Enzootic abortion causes foetal death in late pregnancy or birth of very weak lambs that rarely survive. Ewes are often well in themselves at the time of abortion

Enzootic abortion in ewes (EAE) is caused by the small, Gram-negative bacterium, Chlamydophila abortus.

The Chlamydia bacteria infect the placenta, damaging it and so affecting (and often stopping) the development of the lamb

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What does the disease look like?If infection occurs more than 6 weeks from birth, it remains latent and remerges in the subsequent pregnancy (causing abortion or weak lambs)

YEAR 1

Conception

or

Aborted lamb

Infected lamb (rarely survives)

6 weeks before due date

Due date

YEAR 2

Conception

Infected less than 6 weeks before due date

Infected becomes latent - remains within sheep

Infected more than 6 weeks before due date

or

Aborted lamb

Infected lamb (rarely survives)

or

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2. MEARNS, 2007

Abortion often occurs in ‘storms’, with typical abortion rates of 30%2

In unvaccinated flocks:• Even though ewes have solid immunity post-abortion, in endemic flocks,

an abortion rate of 5% a year can be seen. However, a typical feature of EAE is abortion storms that can involve 30% or more of ewes

• 2-3 years after infection is introduced into the flock, abortion rates drop below 10%, then a new bout of abortions can occur in first time lambers and new replacement animals

Naive, infection free flock 1st season 2nd season

High abortion rate. Those infected less than

6 weeks from delivery become latently infected

Replacement stock is introduced carrying latent infection

Currently uninfected flock, no history of abortion

Those infected last year are immune BUT those with latent infections

from last year abort this year First time lambers and naive

bought in animals are susceptible to infection, so abortion rates in this group are high. Those infected less

than 6 weeks before delivery become latently infected, aborting in the

following season...

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How disease is spread

1. LONGBOTTOM, 2012 3. WILSMORE, 1984

Possible infection route:Neighbouring sheep/escaped sheep Possible infection route:

Wildlife

Lambs can becomeinfected in their

own perinatal period3

Infected afterbirth andvaginal discharges are

highly infective

Chlamydophila abortus bacteriaremain capable of infection

in the environment for about 6 weeks

Possible infection route:Dogs

Possible infection route:Groundwater

One of the main routesof transmission is via theintroduction of infected

replacement animals1

(including replacement rams)

A biosecurity risk always exists, even in closed and EAE-free flocks

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1. LONGBOTTOM, 2012

Chlamydophila abortus can be dangerous for humans

Enzootic abortion affects your margins

Typical abortion storms average 13% loss, but can reach 50%Financial implications extend beyond just the loss of aborted lambs, and can also include:

Costs of investigating an abortion storm (vet and laboratory fees)

Costs associated with barren ewes (loss of ewe herself and cost of replacement)

Disposal fees

Cost of medicines to treat suitable ewes

Extra labour costs (treatments, organisation of aborted material disposal and disinfection, weak lamb support etc.)

Increased mortality/ morbidity of weak lambs

Reduced milk yield of affected ewes

2. MEARNS, 2007

Impact of disease

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FARMER CALCULATOR

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Chlamydophila abortus can be dangerous for humans

The bacteria is zoonotic (can infect people as well as sheep) with the potential to cause miscarriage in pregnant women

Bacteria can remain in the environment with the potential to cause infection for up to 6 weeks.

Infection with the bacteria can also cause flu-like symptoms in people

For more information about Chlamydophila abortus infection in people, please refer to governmental health protection advice at www.gov.uk/chlamydophila-abortus

Impact of diseaseCevac®

Chlamydia

Therefore all pregnant women should avoid contact with sheep around and after lambing time. Additional sensible precautions include:

– Avoiding contact with clothing or equipment that could have been contaminated

– Ensuring that people who have been in contact with sheep during lambing wash thoroughly before having contact with pregnant women or her environment





Latent infections




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http://www.gov.uk/chlamydophila-abortus

Control of disease

Prevention via vaccination is the best form of control

Vaccinate with Cevac Chlamydia to prevent enzootic abortion

IN THE FACE OF AN OUTBREAK

First yearVaccinate whole flock

1-2 months before tupping

Following yearsVaccinate all bought

in replacements. 1-2 months before tupping

(do not mix sheep until 4 weeks after vaccination)

Vaccinate all ewe lambs destined to be replacements

From 5 months of age

After 4 yearsConsider booster vaccination

of whole flock

1-2 months before tupping

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Control of disease

Healthy ewes

Abortions

Excreting ewes

Protected ewes

YEAR 1

JAN DEC

YEAR 2

YEAR 3

YEAR 4

Reduction of infection in an infected flock following vaccination with Cevac Chlamydia

Ewes who are infected will develop solid immunity, but this is not a good long term control strategy

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Why Cevac Chlamydia?Cevac Chlamydia is a live attenuated vaccine that provides efficient protection against enzootic abortion in non-infected ewes and ewe lambs and helps reduce excretion

Cevac Chlamydia is available in 20 and 50 dose bottles, in practically sized packaging for fridge storage

Ceva is proactively driving sheep farmers to vets via education and practice tools

The Cevac Chlamydia vaccination administration system includes state of the art technology that reduces the risk of needle stick injuries, injection site abscesses and transmission of disease

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The Cevac vaccination kit Sterimatic needle protector

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Vaccine mode of actionHow vaccination with Cevac Chlamydia interrupts the pathogenic process

Sheep who have been infected with Chlamydophila abortus develop a strong immunity afterwards, preventing future infection.

Cevac Chlamydia takes advantage of this natural immune response by introducing a harmless (live attenuated) version of the bacteria, which the sheep’s immune system then recognises as foreign and so mounts an immune response against.

Part of this immune response is the production of antibodies, which stick to the outside of the bacteria and attract other immune cells which then destroy the bacterial cells.

These antibodies remain in the sheep and so if it encounters harmful, infective Chlamydophila abortus bacteria via natural exposure, the antibodies are already present to stick to those bacteria and quickly facilitate their destruction, before they have chance to reach the placenta and cause damage.

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Latent infections




Zoonotic Risk





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8: FAQs



Why Cevac Chlamydia?Cevac Chlamydia is available in 20 and 50 dose bottles, in practically sized packaging for fridge storage

Cevac®





Latent infections




Zoonotic Risk





Pack sizes




8: FAQs



Cevac vaccination kitOne Cevac vaccination kit includes:

2ml bottle mounted syringe. (Selecta dose 0.2ml increments)

Sterimatic green needle guard (22mm) 5 x Stericaps

5 x 18G 1” metal hub needle

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Sterimatic needle protectorThe Cevac vaccine kit incorporates the Sterimatic needle protector and cleaning system:

– Reduces needle-stick injuries

– Reduces infection and abscessing

– Reduces disease transmission

Maintenance advice:1. Flush through using water over 60 degrees celsius2. Lubricate O-ring3. Store in a clear bag out of direct sunlight4. Before use clean again with water over 60 degrees celsius Always wear gloves when handling the injector and do not handle if pregnant

Sterimatic needle guard• Reduces needle-stick injuries • Reduces needle damage • Options for subcutaneous

or intramuscular injections

Stericap• Automatically cleans with every Injection• Reduces infection and abscessing • Reduces disease transmission• 100 Injections per Stericap

Recommended by vets and independently testedEffective against contaminants including FMD, bluetongue, PRRS, leukosis, E. coli, staph

Attaches to many syringes including Simcro, ISL, Phillips, Primatech, Henke, Trade-Unlimited and Hauptner.

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Vaccination points to consider

Vaccinated animals can generate an antibody response, which can result in false positive test results during diagnostic screening

Antibiotics should not be given at the same time to animals that have been vaccinated with the ‘live’ commercial vaccine. This would reduce the effectiveness of the vaccine.

Vaccination does not modify the development of disease in already infected ewes at the moment of vaccination

In very rare cases vaccine strain can be found in cases of abortion. However, vaccination still remains the most effective means of protecting against disease.

REMEMBER, there may be abortions the year following vaccination due to latent infections

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FAQsWill Cevac Chlamydia reduce the number of abortions in latently infected animals?We believe that it does but there is no official data to quantify this.

Can oxytetracycline be used with Cevac Chlamydia?Oxytetracycline must not be given at the same time as Cevac Chlamydia. In the past it has been advised that ideally it should be given no less than 7 days prior to vaccination or at least 8 weeks after. It is now believed that a 4 week period post vaccination is sufficient.

How long does the Cevac Chlamydia vaccination last?A booster vaccination may be required after 3-4 lambings. However, most farmers only vaccinate once and it is unusual to get reports of older vaccinated ewes aborting. For full details, please refer to the SPC guidelines: http://www.noahcompendium.co.uk/Ceva_Animal_Health_Ltd/CEVAC_Chlamydia/-40243.html

Can you use Cevac Chlamydia in lactating sheep?Cevac Chlamydia should only ideally be given to non-lactating animals. However, in the event of an outbreak, it has been used off license in lactating animals with minimal reactions. The withdrawl period for this should be a minimum of 7 days.

How long does a vial of Cevac Chlamydia last once it has been reconstituted?A reconstituted vial must be used the same day and ideally within 2 hours.

What are the best needles to use for the Cevac Chlamydia gun if replacements are required?18g 1.5” s/c or 2” i/m needles. All metal is best. The needles need to be long due to the needle guarding system.

Can I use Heptavac P Plus at the same time as giving Cevac Chlamydia?Efficacy or safety of either vaccine if they are used at the same time cannot be guaranteed. Heptavac P Plus primary course should be given as lambs and then a booster prior to lambing. Cevac Chlamydia should not be given at either of these times i.e. >5months of age and not when a ewe is pregnant. The only vaccination that is confirmed as safe to be used at the same time is Toxovax.

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http://www.noahcompendium.co.uk/Ceva_Animal_Health_Ltd/CEVAC_Chlamydia/-40243.html

http://www.noahcompendium.co.uk/Ceva_Animal_Health_Ltd/CEVAC_Chlamydia/-40243.html

FAQsWhat length of time should there be between vaccination with Cevac Chlamydia and tupping?A grace period of a minimum of 4 weeks between vaccination and tupping is recommended. A shorter period could lead to reduced fertility in the flock and possibly reduce efficacy of vaccine. It is also a live vaccine so can potentially lead to vaccine abortions.

Can Cevac Chlamydia be used at the same time as Toxovax?Yes. The datasheet advises that it can be given on the same day as Toxovax but not at the same site or using the same syringe.

Can Cevac Chlamydia be given in May?Yes, providing all the following criteria are satisfied:• Must not be given to pregnant ewes or for 4 weeks before tupping.• The possible post vaccination pyrexia may have implications in the immediate period

post lambing period – possibly adversely affect on the maternal bond, milk production or recovery from lambing.

• Ewe lambs must be >5 months• Ideally not given in the first week post lambing due to a spike

in body temperature

Can I use Cevac Chlamydia that is out of date?Cevac Chlamydia is a live vaccine, so it should not be used outside of its expiry date.

Can Cevac Chlamydia be used in goats?It has been used in goats, but this represents off-license use, so please speak with a Ceva technical advisor before using in this way - 01494 781510

What should I do if self injection occurs?Immediate medical advice should be sought and the doctor informed that self injection with a living Chlamydophilia vaccine has occurred. Tetracycline therapy is the current recognised treatment for infection with Chlamydia abortus in humans.

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In the face of an outbreak

1

23456

1. Apply control measures in the face of an outbreak: Send samples for diagnostics: put aborted lambs and placenta in a clean

double bag and submit for investigation. Serological testing is the only way to identify the causal agent and get a definite diagnosis.

Mark and isolate aborting ewes ideally for 3 weeks. Remove and destroy bedding and abortion products. Care must be taken when handling aborted sheep and material, use gloves! Disinfect the pen before it is used again. Do not foster lambs on ewes that have aborted.

2. Antibiotics can be used to reduce EAE losses if infection is diagnosed early in the lambing season

However, treatment of ewes with a long-acting oxytetracycline in the face of an outbreak will not reverse any damage already done in the uterus. Treat all in-contacts between 105-120 days pregnant.

– Oxytetracycline can have some effect against the bacteria when it is in cells and actively multiplying, but it has no effect on the extracellular form

3. Buy replacement stock from EAE accredited farms

4. Implement an effective vaccination programme The cost of vaccination with live vaccines is offset by its protection,

which in many flocks is a one-off cost per ewe.

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Relevant clinical papers

In Practice ● JA N UA RY 20 0740

INVESTIGATING ABORTION OUTBREAKS

Information gatheringIn many cases, abortion occurs weeks or months after an infection has been acquired, and there is often very little that can be done to halt an abortion outbreak once it is in progress. However, there is still a need for inves-tigation, and a diagnosis is most likely to be made from abortion material submitted at the time. Management decisions can then be made for future years based on the confirmed cause.

In the event of an abortion outbreak, a detailed history should be taken, comprising both general infor-mation about the flock and more specific information pertaining to the abortions seen so far (see box below).

FA

RM

AN

IMA

L P

RA

CT

ICE

ABORTION in sheep flocks is estimated to have a national annual incidence of 2 to 3 per cent, although some flocks may experience abortion storms involving large numbers of ewes. This article, the first of two on ovine abortion, discusses the priorities in the event of an outbreak, and reviews the diagnosis, and available options for control and prevention, of the most common infectious causes of abortion in the UK: namely, Chlamydophila abortus (the agent of enzootic abortion of ewes), Toxoplasma gondii and Campylobacter species. Together, these make up over 70 per cent of diagnoses based on submissions of abortion material at veterinary disease surveillance centres throughout England, Scotland and Wales. Part 2, to be published in the next issue, will discuss other common infectious causes, as well as some exotic diseases that pose an abortion risk to UK flocks.

Abortion in sheep

1. Investigation and principal causes

REBECCA MEARNS

In Practice (2007) 29, 40-46

Submission of samples for investigationIdeally, material from every abortion should be sub-mitted to the nearest disease surveillance centre (SAC in Scotland and VLA regional laboratories in England and Wales) for full investigation. However, this is rare-ly economically feasible and so, as a guide, abortion material should be submitted when over 2 per cent of ewes have aborted over the lambing period, or when clusters of abortions occur within a flock. Most labora-tories offer a batch charge for the examination of fetuses and placentas from two to four ewes. This offers the best chance of reaching a diagnosis at the least cost to the farmer.

Abortion material (fetuses and placentas) should be double bagged, labelled and sealed before submis-

Rebecca Mearns graduated from Cambridge in 1998, and spent three years in mixed practice before undertaking a placement with Voluntary Service Overseas as a vet for the Malawi Government. On her return to the UK, she continued in mixed practice in Cumbria, gaining the RCVS certificate in sheep health and production in 2004. Following two years as a veterinary investigation officer for the Scottish Agricultural College (SAC) in Edinburgh, she now works for the Veterinary Laboratories Agency (VLA) at the Penrith regional laboratory.

Checklist for a comprehensive history

Flock information ■ Number of ewes and flock type■ Expected lambing dates■ Are the ewes housed for lambing? If so, when?■ What are the ewes fed and how much?■ Is the flock closed or are replacements bought in? If so, from where? ■ Have abortions occurred in

previous years? If so, what was the cause, if known?■ What vaccinations are used?■ Ultrasound scanning data, if available■ Have the ewes undergone recent handling or transporta-tion?

Specific information ■ How many abortions have occurred?

■ Dates of abortions so far■ Are the ewes that aborted sick?■ What age are the ewes that are aborting?■ Are the ewes homebred or bought in?■ What did the aborted lambs look like?■ Have the ewes that aborted been isolated from ewes yet to lamb?

An abortion outbreak is one of the most common reasons for sheep farmers to seek veterinary advice, and it provides a good opportunity to visit sheep farms and discuss biosecurity, management of pregnant ewes and newborn lambs, and production targets

group.bmj.com on March 25, 2015 - Published by http://inpractice.bmj.com/Downloaded from

Short Communication

Evaluation of the impact and control of enzootic abortion of ewes

David Longbottom a,⇑, Gary Entrican a, Nicholas Wheelhouse a, Helen Brough b, Catherine Milne c

aMoredun Research Institute, Pentlands Science Park, Bush Loan, Edinburgh EH26 0PZ, UKb Epidemiology Research Unit, SAC, Drummondhill, Stratherrick Road, Inverness IV2 4JZ, UKc SAC Edinburgh, Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh EH9 3JG, UK

a r t i c l e i n f o

Article history:Accepted 13 June 2012

Keywords:Chlamydia abortusEnzootic abortion of ewesVaccinationDisease controlFarmer survey

a b s t r a c t

Despite the availability of effective management and treatment strategies, Chlamydia abortus remains thesingle most frequently diagnosed cause of infectious ovine abortion (enzootic abortion of ewes, EAE) inthe UK and one of the most significant causes of lambmortality world-wide. In 2007, a survey of UK farm-ers, veterinarians and other farm animal holders was conducted to gather information on their percep-tions of the risk of acquiring infection and the management practices employed to control the disease.The survey indicated that the preferred options for controlling EAE are either through vaccination and/or keeping flocks closed. However, further analysis of data indicates that implementation of these strat-egies does not provide a guarantee of exclusion of disease from flocks and thus further work is required toimprove on current intervention strategies.

� 2012 Elsevier Ltd. All rights reserved.

Infectious ovine abortion is a major health problem in sheepworld-wide, having significant financial and welfare implications.While several organisms are capable of causing infectious abortionin sheep,1 the single most common cause in the UK is the bacteriumChlamydia abortus, the aetiological agent of enzootic abortion ofewes (EAE), also known as ovine enzootic abortion (OEA) (Longbot-tom and Coulter, 2003).

In 2007, a survey of farmers, veterinarians and other veterinaryworkers was conducted to determine the management strategiesused for controlling EAE, their understanding of control optionsand perceived risks for acquiring infection. A convenience sam-pling method was used to achieve good coverage throughout theUK. Questionnaires (see Appendix A: Supplementary material)were distributed through the Moredun Foundation, which has anextensive UK-wide membership network, as well as through Qual-ity Meat Scotland and at all major UK agricultural shows.

The survey response rate was 22% (442/2000 questionnaires re-turned); the results are summarised in Table 1. Among respon-dents, 33.8% reported cases of EAE (28% in Scotland, 37% inEngland, 38% in Wales and 70% in Northern Ireland). This is similarto the figures published by DEFRA for diagnosed cases of ovinefetopathy2 and therefore the responses are considered to offer agood representation of the EAE situation in the UK. Lowgroundand upland farms had a higher prevalence (40.7%) than hill (16.7%)or pedigree farms (8.6%). Lowground, upland and hill flocks are

differentiated by land type and have different systems of flock man-agement; lowground flocks typically have higher sheep–sheep con-tact levels than upland flocks and much higher contact levels thanhill flocks. The prevalence of EAE was significantly lower in flocksof <150 animals (9.4%) than in larger flocks (47.6%).

Due to the ‘silent’ or latent nature of infection, where the organ-ism lies dormant in non-pregnant ewes until a subsequent preg-nancy (Longbottom and Coulter, 2003), introduction of infectedreplacement animals is one of the main routes of transmission.This was recognised by 55.8% of respondents, who believed thatreplacements were the major source of disease. This risk can beminimised by maintaining a closed flock or through the purchaseof EAE-free accredited animals, such as those within UK healthschemes.3,4

Most respondents (63.6%) indicated that they had closed flocks,22% bought from non-accredited sources and 14.4% reported thatthey always or sometimes purchase EAE accredited replacements.Respondents that had experienced EAE were more likely to pur-chase replacements from non-accredited sources (32.4%) thanthose that had not experienced the disease (16.6%). Other sug-gested sources of infection included replacement rams, wildlifesources, feral sheep, dogs or groundwater, for which there is someevidence of a role in the spread of EAE (Appleyard et al., 1985;Mainar-Jaime et al., 1998; Lemus et al., 2010).

Other approaches to disease control include the use of diagnos-tic screening, antibiotics and vaccination. Diagnostic screening is away of monitoring the EAE status of a flock to identify infected

1090-0233/$ - see front matter � 2012 Elsevier Ltd. All rights reserved.http://dx.doi.org/10.1016/j.tvjl.2012.06.018

⇑ Corresponding author. Tel.: +44 131 4455111.E-mail address: [email protected] (D. Longbottom).

1 See: http://www.vla.defra.gov.uk/reports/rep_vida.htm.2 See: http://www.vla.defra.gov.uk/reports/docs/rep_vida_sheep00_07.pdf.

3 See: http://www.sac.ac.uk/consulting/services/i-r/sghs/.4 See: http://www.hisha.org.uk.

The Veterinary Journal 195 (2013) 257–259

Contents lists available at SciVerse ScienceDirect

The Veterinary Journal

journal homepage: www.elsevier .com/ locate/ tv j l

1. LONGBOTTOM, 2012 2. MEARNS, 2007 3. WILSMORE, 1984

Licensed for use with toxoplasmosis vaccine, can be used on the same day at seperate injection sites. Cevac®Chlamydia contains live attenuated 1B strain of Chlamydophila abortus vaccine. Legal category POM-V Use medicines responsibly (www.noah.co.uk/responsible)

Further information is available from: Ceva Animal Health Ltd, Unit 3, Anglo Office Park, White Lion Road, Amersham, Bucks, HP7 9FB. Tel: 01494 781510. www.ceva.co.uk

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Longbottom_2012.pdf

In_Practice-2007-Mearns-40-6.pdf

Wilsmore_1984.pdf

http://www.noah.co.uk/responsible

http://www.ceva.co.uk

Documents

Cevac Chlamydia - NADIS · Cevac® Chlamydia Cevac® Chlamydia 1: EAE – stats and facts 2: What does disease look like? How do I know it’s an infectious cause? How does Chlamydophila