FIP Cyprus Outbreak: The Experts Share Insights

On June 10, 2023, veterinary researchers posted an ALERT to the British Veterinary Association publication VET RECORD: Cyprus FIP outbreak is ‘very alarming’

The outbreak began in January 2023 in the capital city of Nicosia, with increasing numbers of cases reported in the districts of Larnaca, Limassol and Famagousta. “Within 12 weeks the number of PCR-confirmed FIP cases increased more than 20-fold compared to the previous year,” according to the Vet Record report.

An outbreak of FIP (feline infectious peritonitis) means devastating disease and usually death to companion cats as well as feral or community cats. Testing complicates matters—there is no single definitive test—and only recently have effective anti-viral treatments become available. But these treatments take up to 12 weeks, costs a lot, and the drugs are not FDA approved for veterinary use, and therefore difficult to get.

FIP Cyprus Outbreak, A Confusing Issue

While Cyprus seems a world away to those of us in the United States, we know from recent experience that diseases may rapidly spread. The news led to media inquiries resulting in scary, confusing, and even contradictory reports in the press.

For example, one outlet mis-characterized FIP as “cat COVID” which is wrong on multiple levels. While cats may contract the human illness, and veterinary researcher Danielle Gunn-Moore (a contributor to the VET RECORD warning) says up to 15% of cats test positive for COVID, the feline coronavirus implicated with FIP does not affect people.

“Cat owners should know that the virus that causes FIP is different than the one that causes COVID,” says veterinary researcher Krystle Reagan. However, because the two coronaviruses are related, drugs that benefit human COVID also have applications for cats diagnosed with FIP.

Another outlet reported 300,000 cat deaths from the outbreak, based on estimates from an individual working in a cat shelter. “This is not reflected in our current data,” says veterinary researcher Charalampos Attipa, one of the contributors to the VET RECORD warning.

Experts Offer Insight into FIP Outbreak

Dr. Attipa, Dr. Reagan, and Dr. Gunn-Moore  kindly answered my questions when I reached out to veterinary experts for further clarification.

Charalampos Attipa, DVM, MRes, MVetMED, DipACVP, PhD, MRCVS, RVCS is an American Recognized Specialist in Veterinary Clinical Pathology. He is an Associate Professor/Senior Lecturer in Veterinary Clinical Pathology at The Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh.

Krystle Reagan, DVM, PhD, DACVIM (SAIM) is an Assistant Professor of Small Animal Internal Medicine; Co-Director, Veterinary Center for Clinical Trials, at UC Davis School of Veterinary Medicine.

Dr. Danielle Gunn-Moore, BSc(Hon), BVM&S, PhD, MANZCVS, FHEA, FRSB, FRCVS, RCVS Specialist in Feline Medicine, Professor of Feline Medicine, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, and member of the FIP Clinical Research Team.

What Is FIP (Feline Infectious Peritonitis)

FIP arises from a feline coronavirus (that doesn’t affect people). In most cats, it causes transient mild diarrhea. But in up to 10 percent of infected cats, the virus mutates into the virulent FIP form. Kittens and young cats develop the disease most often.

“Up to 50% of whether or not a particular cat that is infected with FCoV actually goes on to develop FIP is down to its genetics,” says Gunn-Moore.

Early nonspecific (vague) signs include a waxing and waning fever, lethargy, and anorexia arising from severe inflammation in tissues around the kidneys, abdomen, and brain. The “wet” form of the disease causes a swollen, distended tummy; the “dry” form can prompt neurological signs, like seizures.

Previous outbreaks of FIP have occurred in the U.S., U.K. and Taiwan but were confined to catteries and shelter adoptions. Local veterinarians in Cyprus report the disease also has stricken indoor-only cats.

Reagan says, “This is certainly an alarming situation in Cyprus. There are still many unknowns about why this increase in number of cats with FIP is being observed.”

“The PCR confirmed cases we have are a few hundreds. Of course, they are the tip of the ice-burgh, but we are working with epidemiologist to properly estimate the real size (of the outbreak),” says Attipa. “We are suspecting that there is a new strain, and currently we are performing sequencing here at Edinburgh university to better understand what has happened.”

Where Is Cyprus?

The small island of Cyprus sits in the Mediterranean Sea, with Turkey to the north, Syria to the east, and Lebanon off the south-east coast. Known as the “Island of Cats,” Cyprus holds some of the earliest archeological evidence of cat-human interaction.

Cyprus is an independent country member of UN and EU. The south region is the official EU-State control part, Turkey occupies the north. In addition, Britain has interests in the island (see the map). The beauty and climate—and cats—make Cyprus an attractive vacation spot for many.

Why Does This Matter?

The cat-loving society boasts (anecdotally) 1.2 million owned and free-ranging felines. Many of the companion felines have indoor-outdoor access, making the environment the perfect storm for incubation and spread of potential diseases in this isolated population. Other factors remain unknown and under investigation, but experts urge people on Cyprus to confine their cats indoors to prevent potential exposure.

With FIP on the rise on this isolated island, measures to prevent the disease’s spread become vital. Anecdotal data from other vets suggest the Cyprus variant has already been found in Turkey, Lebanon, and other middle east countries.

“We are trying to avoid spreading of the virus outside Cyprus and investigating what has caused this outbreak, that can potentially occur in other countries,” says Attipa.

Dr. Danielle Gunn-Moore says they believe the outbreak began in Turkey. She and other researchers now analyze the (FCoV) virus from before and during the outbreak to determine how they differ. They also want to establish a system to monitor the Cyprus outbreak, to help reduce future risk or spread outside of the island.

UPDATE from Dr. Gunn-Moore

Since FIP arises in cats genetically predisposed for the coronavirus to mutate, I wondered whether the Cyprus cats might be a more genetically prone population? Or perhaps the Cyprus coronavirus mutated into a more virulent universally-infectious form that easily becomes FIP? Dr. Gunn-Moore graciously responded with the following:

“I think the most likely possibilities are a ‘hot’ strain of FCoV,” says Gunn-Moore, “perhaps most likely type 2 FCoV as they arose from a recombination event with canine CoV and FCoV, and are perhaps more likely to develop a Spike mutation that is quite different from the previous strain. This mutation would allow the virus to replicate to such high levels that when the infected monocytes in the blood pass back through the bowel they can be shed, or it can replicate within feline enterocytes and monocytes.”

Some have speculated if SARS-Cov 2 (the human COVID virus) has recombined with FCoV. But she doesn’t think this likely because cat coronaviruses are alpha type coronaviruses while SARS CoV 2 is a beta. “That said, type 2 FCoV (feline coronavirus) are made from the recombination of type 1 FCoV and canine coronavirus (which is also an alpha type coronaviruse). Could an alpha type coronavirus recombine with a beta type coronavirus? I simply don’t know.”

A third speculation poses that cats infected with SARS CoV 2 (human COVID virus) have made them at a greater risk of developing FIP. This may have been the root of some of the earlier reporting, conflating COVID with the FIP situation on Cyprus. Gunn-Moore says a number of cats have been infected with SARS CoV 2, with some developing clinical signs and some even dying from clinical disease. But nobody knows the full extent of the impact of COVID on cats, or how much of this went on during the pandemic.

“I think this may possibly be playing a role. In studies around the world, up to 15% of cats are now seropositive for SAR CoV 2. We know that antibodies to FCoV can induce antibody enhanced disease (ADE) in cats, increasing their risk of developing FIP. This is why so many attempts to develop a good vaccine for FIP have failed – they kill some of the cats they’re supposed to protect, especially when it was a heterologous challenge virus. Could it be that the heterologous antibodies to SAR CoV 2 are causing ADE?”

She goes further to say, “You ask about the role that the host genetics can play. Yes, it could be that the stray cats on the island are inbred. However, given that we think this outbreak started from Turkey and is also in the Lebanon, this suggests that the FCoV that is causing the “FCoV-23 outbreak”,  is more virulent highly infectious form that easily causes FIP.”

Any Good News about Cyprus and FIP?

A vaccine for FIP, while available and safe, has not shown effectiveness and American Association of Feline Practitioners Feline Vaccine Advisory Panel recommends against using it. “Research is ongoing on the vaccine side of things,” says Reagan, “but I think it will still be several years before we see clinical studies on a vaccine.”

“The good news is that it sounds like there are cats that are responding to anti-viral therapy,” she says. “I’m not sure which anti-viral they are using in Cyprus, but yes, GS-441524, remdesivir, and molnupiravir all seem to have efficacy in treating cats with FIP – but sadly none of them are licensed for veterinarians to use in the US.”

What Veterinarians Need to Know

The alert and warning in the Vet Record says, “To avoid spread of this FCoV strain outside the island, we urge veterinarians to serologically test any cat before it travels outside of Cyprus. Any seropositive cat should not travel outside Cyprus until we have a better understanding of the current outbreak. Ideally, if a cat is allowed to travel it should be kept indoors for 10 to 14 days and retested, as acutely infected cats will likely seroconvert at a later stage.”

The warning emphasizes U.K. considerations, since parts of Cyprus are overseas British territories. Citizens of Great Britain may live there permanently or seasonally.

What Cat Lovers Need to Know

For show cats or adoption options from Cyprus (or surrounding locales), avoid contact with cats that traveled in this region. “At the moment we cannot differentiate the “old” FCoV with this new strain,” says Attipa.

Reducing or preventing exposure to coronavirus offers the best current prevention. Most kittens and young cats, though, become exposed early in life. Those from crowded, unsanitary conditions have the highest risk.

“Groups that work with cat colonies should be on the lookout for cats that are lethargic, losing weight, or generally in poor health and have them evaluated by a veterinarian,” says Reagan. “There are no vaccines currently available that protect cats from FIP.”

If your cat displays symptoms, and/or your veterinarian suspects or diagnoses FIP, research treatment options like those shared in this interview and discuss with your veterinarian.

Funding FIP Research

Attipa says, “As someone that was working with human diseases in Africa during the COVID-19 pandemic, I can say we need significant larger amounts of money to support research in FIP regarding the pathogenesis, better treatments and ultimately a vaccine.” UPDATE: The BRITISH VETERINARY ASSOCIATION has released a statement.

EveryCat Health Foundation (formerly Winn Feline Foundation) has funded multiple studies to learn more about the disease, treatment, and prevention. You can donate to a specific fund (The Bria Fund focuses on FIP) or to general fund for research, in honor (or memory of) a special person or cat. Learn more here.

Morris Animal Foundation also has funded multiple studies into FIP research, including studies that led to the first anti-viral drug treatment for FIP cats. Learn more here to support the research.

AUTHORS OF VET RECORD CYPRUS FIP WARNING INCLUDE:

• Charalampos Attipa, senior lecturer in
  veterinary clinical pathology
• Danielle Gunn-Moore, professor of feline
  medicine
• Stella Mazeri, EBVS European Specialist in
  veterinary public health
• Royal (Dick) School of Veterinary Studies
  and The Roslin Institute, University of
  Edinburgh, Easter Bush Campus, Midlothian
  EH25 9RG
• Demetris Epaminondas, vice president of
  the Pancyprian Veterinary Association
  Veterinary Services, Ministry of Agriculture,
  Natural Resources and Environment, Cyprus
  Maria Lyraki, EBVS European Specialist in
  small animal internal medicine
  Vets4Life Referral Hospital, Athens, Greece
• Alexandros Hardas, lecturer in veterinary
  anatomic pathology
  Department of Pathobiology and Population
  Sciences, Royal Veterinary College, Hatfield,
  Hertfordshire AL9 7TA
• Stavroula Loukaidou, veterinary surgeon
  Vet Dia Gnosis Ltd, Limassol, Cyprus
  Michaela Gentil, veterinary surgeon
  Laboklin GmbH and Co KG, Bad Kissingen,
  Germany

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Amy Shojai, CABC is a certified cat & dog behavior consultant, a consultant to the pet industry, and the award-winning author of 35+ pet-centric books and Thrillers with Bite! Oh, and she loves bling!