“…Several common themes were identified as contributing to these outbreaks, including high dog density and dog-to-dog contact, 9,35,39 inadequate quarantine of new or returning dogs, 27 poor dog confinement or wildlife exclusion, 9,40 inadequate vaccination, 9 poor vector control, 41 and inadequate disinfection practices. 9,39 Anecdotally, these reports appeared to far underestimate the occurrence of such outbreaks.…”