Visiting Veterinarian

The vaccine scene

By Michele Gerhard Jasny V.M.D. - March 30, 2006

For many years, veterinarians relied on annual vaccination as a method for getting dog and cat patients into their offices regularly. We all knew an annual physical examination was actually the most important part of the visit, but owners seemed more likely to show up if Pokey was due for a "distemper shot" than if we just suggested a "Wellness Exam." The development of vaccinations for such deadly disease as rabies, distemper, parvovirus, feline leukemia virus, and others, was an enormous leap forward for the overall health and longevity of the companion animal population, so it is no surprise that "shots" were given such prominence. However, over the years, several things happened.

Many of these diseases became less common as a result of widespread immunization. Pharmaceutical companies developed more and more vaccines for more and more diseases. And people, both in and out of the veterinary profession, began to question which vaccines were truly useful, and how often they really needed to be administered. Similar controversy rages in the human medical community with many patients and practitioners questioning traditional vaccine protocols. At one extreme we have health care providers who doggedly hang onto old routines. At the other extreme we have those who would eliminate all vaccinations. In the middle are a lot of sensible, well-educated, open-minded people who don't want to over-vaccinate but don't want to throw the puppy out with the bath water, either

In 2003, the American Animal Hospital Association (AAHA) published their first set of Canine Vaccine Guidelines. They created a little stir by officially suggesting that the revaccination interval on numerous doggy vaccines be extended from annually to triannually. Many veterinarians had already made this transition independently, but others, wanting more scientific data to support the shift, and leery of the risk of malpractice lawsuits if they did not follow manufacturer label recommendations, stuck with the yearly protocols.

Older vets have perspective
As the controversy grew, some people accused these veterinarians of basing their recommendations on financial profit, not medical need. I prefer to give these docs the benefit of the doubt. Those of us who are old enough to have actually seen things like Parvo epidemics may be more conservative about reducing vaccinations. Anyone who spent a week, like I did, in the "Parvo Ward" at the University of Pennsylvania in the late 1970s will never forget the horrific odor of bloody viral diarrhea and vomit mixed with disinfectant, and the relentless sorrow of watching dozens of dogs and pups die, week after week, from this terrible virus. The development of the Parvo vaccine was welcomed as a great blessing.

But it is now 2006. AAHA has just updated and published new Canine Vaccine Guidelines. It is true that an annual physical examination is still a wonderful thing for Pokey. We often pick up problems that owners fail to notice. We may also advise other preventive health care on an annual basis, such as Lyme and heartworm screening and fecal testing for intestinal parasites. There are other vaccinations, such as those for Lyme or kennel cough that may be warranted annually for certain dogs. But in my mind, there is no longer any excuse for the veterinary profession to base our wellness care on a one-size-fits-all annual vaccination plan. Our job is to educate you and tailor vaccinations to Pokey's specific lifestyle and medical needs.

So what do the Guidelines say? There are four "Core Vaccines" that every puppy/dog should receive: rabies, canine distemper, canine parvo, and canine adenovirus-2, which us old-timers call hepatitis. They have a slogan. "No Dog Should Be Left Unvaccinated!" By this they mean that every dog should receive at least one dose of each core vaccine when they are 12 weeks old or older. If this goal were achieved, it would provide a level of "population immunity" that would keep the incidence of these diseases very low, maybe even eliminate them eventually. Why the age specification? Because puppies receive antibodies in their mother's milk that give them "passive immunity" which temporarily protects them from contracting diseases, but interferes with their response to the vaccines. By 12 weeks of age, this passive immunity has passed, and Pokey's immune system has matured sufficiently to have a good response.

So is that it? Just one of each vaccine at 12 weeks and you're done? Nope. For all the Core Vaccines except rabies, to insure optimal immunity, Pokey Puppy should have a shot at 6-8 weeks then every 3-4 weeks until he is 12-14 weeks old. If Pokey is an adult who has never received prior vaccines, he should have an initial dose followed by a booster in 3-4 weeks. Then Pokey should get a booster one year later. After that, in spite of the fact that annual boosters are recommended by some vaccine manufacturers (you figure it out), studies have shown that the duration of immunity (DOI) for the core vaccines may be five to seven years, or longer. The 2006 Guidelines advise Core Vaccine boosters "once every three years or more." Rabies is another story. Because this incredibly scary disease can infect (and kill) people, vaccination protocols are state-regulated. In Massachusetts the law for dogs requires one vaccine after 12 weeks of age, a booster a year later, then a booster every three years.

Common sense called for
What if your veterinarian or your boarding kennel insists on annual distemper or parvo vaccination for Pokey? I think it makes sense to challenge this advice. If annual revaccination is not needed to maintain immunity, why put Pokey at unnecessary risk of having a bad reaction? Why spend the money? On the other hand, if there has been a recent outbreak of, say, parvo in your area, your veterinarian may have good reason to advise a little extra protection. Still want to avoid that vaccine? Talk to your veterinarian about running antibody titers. It won't save you any money. In fact it will cost you more than just having Ol' Doc pop that shot, but it can tell you if Pokey has good titers against distemper or parvo virus, and high antibody titers have good correlation with protection from disease.

What about all those other shots, like Lyme, kennel cough, leptospirosis, coronavirus, Giardia? There are even new ones coming out for rattlesnake venom, and for periodontal disease. Here's where you should depend on Ol' Doc to help you plan Pokey's protocol, since none of these are considered Core Vaccines. It depends on where you live, how you live, and your veterinarian's individual philosophy. For example, I am a strong proponent of Lyme vaccination but see no reason to vaccinate for Lepto here on the Vineyard. Other Island vets may have differing opinions.

Educate yourself. Discuss Pokey's protocol with your veterinarian, and understand why each vaccine is recommended or not. The decision ultimately rests with you.

And veterinarians? We must focus on patient care and professional integrity, and not worry about the economics. Nor should we use annual vaccination as a management tool.