I still would use heart worm preventative. While I do live in a high mosquito area, I’ve seen puppies younger than 1 year with heartworm. Not defective or abused or overvaccinated or anything. Just pups who weren’t given preventative. I would never risk the health of my dog by not giving heartworm preventative. Flea and tick, you can skip if you want.
And there are probably plenty of undiagnosed cases of heartworm; you can’t rely on anecdotes or recorded case numbers. They aren’t an accurate reflection of the actual number of heartworm cases. Plus, some dogs with heartworms will be asymptomatic for a long period. And if they die w/o an autopsy being done, you never know what killed them.
