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Vaccinations Vaccination Protocol, Adverse Reactions, Houston Chronicle Article on Reactions Response to question from Mastiff-Talk on Yahoo groups: Dear Heather (Jackson): Thank you for the inquiry. The principle behind the vaccine protocol that we follow is to start vaccinating a little later [i.e., not before 9 weeks, now that most bitches have been well or even over vaccinated], give the minimum number of vaccine antigens needed for serious diseases in your area in 2-3 doses spread at least 2 and preferably 3-4 weeks apart, give rabies vaccine as late as possible by law in your state ---but separate rabies from the other vaccines by at least 2-3 weeks, give one more booster a year later with the rabies booster separated from the rest, and then start annual serum titer testing instead of more boosters, except as required by law for rabies vaccine. Whew ! That translates to a simple MINIMUM PROTOCOL of Distemper+ Parvovirus only at 9, 12 and 16 weeks [or 9-10, 12-14 weeks] e.g. Progard Puppy DPV, then rabies at 20-24 weeks. If there is infectious canine hepatitis around (rarely seen now, but recently confirmed cases seen in San Diego shelter), then the last distemper/parvo puppy shot could include hepatitis too [DA2P]. If your area has clinical Leptospirosis from the new strains (L. grippotyphosa, L. pomona), then vaccination with the Fort Dodge combo Lepto containing these strains (2 doses) is probably a good idea. We don't routinely use the kennel cough complex for reasons stated earlier. Veterinary immunology experts agree that we should categorize vaccines as "Core" and "Non-Core". All dogs should get the Core vaccines [namely, Distemper, Parvovirus, and Rabies + maybe Hepatitis], whereas Non-Core vaccines are given only if there is some other endemic infectious agent risk in your area. Lyme vaccine is generally not recommended, unless there is very high risk where you live-because you can get significant reactions to the vaccine when animals have already been exposed [i.e., immune-complex antigen-antibody reactions which mimic the joint pain of the disease. Posted to the files before Dr. Dodds joined list: CHANGING VACCINE PROTOCOLS W. Jean Dodds,
DVM The challenge to produce effective and safe vaccines for the prevalent infectious diseases of humans and animals has become increasingly difficult. In veterinary medicine, evidence implicating vaccines in triggering immune-mediated and other chronic disorders (vaccinosis) is compelling. While some of these problems have been traced to contaminated or poorly attenuated batches of vaccine that revert to virulence, others apparently reflect the host=s genetic predisposition to react adversely upon receiving the single (monovalent) or multiple antigen "combo" (polyvalent) products given routinely to animals. Animals of certain susceptible breeds or families appear to be at increased risk for severe and lingering adverse reactions to vaccines. The onset of adverse reactions to conventional vaccinations (or other inciting drugs, chemicals, or infectious agents) can be an immediate hypersensitivity or anaphylactic reaction, or can occur acutely (24-48 hours afterwards), or later on (10-45 days) in a delayed type immune response often caused by immune-complex formation. Typical signs of adverse immune reactions include fever, stiffness, sore joints and abdominal tenderness, susceptibility to infections, central and peripheral nervous system disorders or inflammation, collapse with autoagglutinated red blood cells and jaundice, or generalized pinpoint hemorrhages or bruises. Liver enzymes may be markedly elevated, and liver or kidney failure may accompany bone marrow suppression. Furthermore, recent vaccination of genetically susceptible breeds has been associated with transient seizures in puppies and adult dogs, as well as a variety of autoimmune diseases including those affecting the blood, endocrine organs, joints, skin and mucosa, central nervous system, eyes, muscles, liver, kidneys, and bowel. It is postulated that an underlying genetic predisposition to these conditions places other littermates and close relatives at increased risk. Vaccination of pet and research dogs with polyvalent vaccines containing rabies virus or rabies vaccine alone was recently shown to induce production of antithyroglobulin autoantibodies, a provocative and important finding with implications for the subsequent development of hypothyroidism (Scott-Moncrieff et al, 2002). Vaccination also can overwhelm the immunocompromised or even healthy host that is repeatedly challenged with other environmental stimuli and is genetically predisposed to react adversely upon viral exposure. The recently weaned young puppy or kitten entering a new environment is at greater risk here, as its relatively immature immune system can be temporarily or more permanently harmed. Consequences in later life may be the increased susceptibility to chronic debilitating diseases. As combination vaccines contain antigens other than those of the clinically important infectious disease agents, some may be unnecessary; and their use may increase the risk of adverse reactions. With the exception of a recently introduced multivalent Leptospira spp. vaccine, the other leptospirosis vaccines afford little protection against the clinically important fields strains of leptospirosis, and the antibodies they elicit typically last only a few months. Other vaccines, such as for Lyme disease, may not be needed, because the disease is limited to certain geographical areas. Annual revaccination for rabies is required by some states even though there are USDA licensed rabies vaccine with a 3-year duration. Thus, the overall risk-benefit ratio of using certain vaccines or multiple antigen vaccines given simultaneously and repeatedly should be reexamined. It must be recognized, however, that we have the luxury of asking such questions today only because the risk of disease has been effectively reduced by the widespread use of vaccination programs. Given this troublesome situation, what are the experts saying about these issues? In 1995, a landmark review commentary focused the attention of the veterinary profession on the advisability of current vaccine practices. Are we over vaccinating companion animals, and if so, what is the appropriate periodicity of booster vaccines ? Discussion of this provocative topic has generally lead to other questions about the duration of immunity conferred by the currently licensed vaccine components. In response
to questions posed in the first part of this article, veterinary
vaccinologists have recommended new protocols for dogs and cats.
These include:
In the intervening years between booster vaccinations, and in the case of geriatric pets, circulating humoral immunity can be evaluated by measuring serum vaccine antibody titers as an indication of the presence of Aimmune memory.. Titers do not distinguish between immunity generated by vaccination and/or exposure to the disease, although the magnitude of immunity produced just by vaccination is usually lower (see Tables). Except where vaccination is required by law, all animals, but especially those dogs or close relatives that previously experienced an adverse reaction to vaccination can have serum antibody titers measured annually instead of revaccination. If adequate titers are found, the animal should not need revaccination until some future date. Rechecking antibody titers can be performed annually, thereafter, or can be offered as an alternative to pet owners who prefer not to follow the conventional practice of annual boosters. Reliable serologic vaccine titering is available from several university and commercial laboratories and the cost is reasonable. Relatively little has been published about the duration of immunity following vaccination, although new data are beginning to appear for both dogs and cats. Our recent study (Twark and Dodds, 2000), evaluated 1441 dogs for CPV antibody titer and 1379 dogs for CDV antibody titer. Of these, 95.1 % were judged to have adequate CPV titers, and nearly all (97.6 %) had adequate CDV titers. Vaccine histories were available for 444 dogs (CPV) and 433 dogs (CDV). Only 43 dogs had been vaccinated within the previous year, with the majority of dogs (268 or 60%) having received a booster vaccination 1-2 years beforehand. On the basis of our data, we concluded that annual revaccination is unnecessary. Similar findings and conclusions have been published recently for dogs in New Zealand (Kyle et al, 2002), and cats (Scott and Geissinger, 1999; Lappin et al, 2002). When an adequate immune memory has already been established, there is little reason to introduce unnecessary antigen, adjuvant, and preservatives by administering booster vaccines. By titering annually, one can assess whether a given animal's humoral immune response has fallen below levels of adequate immune memory. In that event, an appropriate vaccine booster can be administered. References
Dear Marge (Lutz): Thank you for the three back-to-back vaccine questions. Most vaccine reactions beyond acute anaphylaxis begin from 3 to 45 days post vaccination. Occasionally, there appear to be some adverse effects to rabies vaccination that show up at 4-6 months later, but the cause-and-effect relationship has not been proven to my knowledge. The adverse effects of vaccines are numerous and do include seizures and blood disorders among other effects, but these occur typically within 3-45 days of vaccination. As far as vaccines brands are concerned, any vaccine can trigger these adverse events in genetically and/or physiologically predisposed animals. So, I cannot comment on a particular brand. Some years back, we always preferred killed vaccine products. The late Dr. Jonas Salk said that a properly constituted killed vaccine is always preferable to a modified live vaccine, because it is inherently safer. Today, however, we don't have many options because there is only one killed parvovirus vaccine on the market (Parvocine, available from Revival Animal Heath). While the killed product does contain more additives (adjuvants to enhance the immune stimulatory response) it doesn't multiply in the vaccinated dog. So, if a large amount of parvovirus antigen would be difficult for the dog's immune system to handle [i.e., when MLV vaccine multiplies 20-fold after vaccination], the killed vaccine would be safer. Titers that develop from killed products tend to be lower than those generated by MLV vaccines and do not last as long. Also, MLV vaccines produce more complete immunity in that they stimulate humoral (serum antibodies), cellular, and secretory immunity, whereas killed vaccines only stimulate the humoral serum immunity, and rely on the host animal's own immune system to stimulate the other systems upon exposure. Either way, parvovirus is a serious disease and the decision about which type of vaccine to use will depend upon your own breed's or dog family's experience and the severity of disease risk in your locale. As far as titer testing and over vaccination issues, the word is spreading. And so you just need to keep up the good front. Change takes time, and thank G-d we are getting there at last ! Jean ----- Dear Bonnie: Vaccination, like any immunologic challenge will suppress the immune system and so could interfere with immune surveillance mechanisms that hunt done occasional cancer forming cells and "kill" them- the so-called "killer cell response". So, in theory if not in practice, there could be increased susceptibility to cancer cell escape from growth control regulation during the 30 days or so post-vaccination. So, unnecessary vaccines or boosters should be avoided. Jean [W. Jean Dodds, DVM] Dear Marge (Lutz): You do not need to give your female booster vaccinations before breeding them, if you've done titers on them during the previous anestrous period --in between heats. That practice is no longer recommended. However, if you really insist on doing it or do not know the vaccine status of a bitch coming to you for breeding, the important thing to remember is to NEVER give a booster once a bitch is already in season-this is too late to be safely done. The time to booster is at least 30-45 days BEFORE the upcoming heat cycle. Whatever the bad experiences we've had, if you just are sure to NEVER booster a bitch anywhere close to her coming to heat, you'll be safe. Jean. Dear Marge (Lutz): There are new vaccine including those for rabies that are made via genetic engineering technology. There are called "recombinant vaccines." These new vaccines will eventually become recognized, but some states are more conservative when it comes to accepting anything new. Your understanding about MLV parvovirus, or any MLV vaccine for that matter, is basically correct. These viruses are immunosuppressive, which I guess, could be considered a form on "immune shutdown." This period takes up to a week. The point about protection levels of material antibody differing between littermate puppies is just misleading. If all the pups got colostrums and are vigorously nursing, all should have similar good levels if protection. Jean Dear Lana (Kirby): Monthly heartworm medications are documented to kill heartworm exposures within the past 45 days, so one could give these medications every 45 rather than 30 days, although this may be difficult for us to remember . In areas of the country where heartworm disease is relatively rare (like our region of Southern CA, many fanciers only give medication if they travel to events in heartworm risk areas-they do so (give the monthly medication) after short trips within 45 days of returning to kill any potential exposures. We recommend using ANY preventive medication only if there is relatively high risk for exposure in your community. We prefer plain daily product or plain monthly product without any flea or tick or other worm product combined. In high flea and/or tick areas we prefer the topical to internal products. This general guideline is especially important for dogs taking many other medications, with liver disease or on anticonvulsants-because we want the liver to be as protected as possible from metabolizing and clearing drugs. Jean Dear Wendee (Lyons): No problems with continuing a successful protocol. One should NOT vaccinate animals going through any illness, especially allergies and cancer or other chronic disease. Some years back (1982, I think), there was an excellent paper from colleagues at UC Davis looking at the effects of booster vaccinating dogs known to have atopic (inhalant) allergies. What they convincingly showed was that IgE-mediated allergies became much worse when vaccination was given. Their conclusion was to avoid vaccinating during periods of high allergy exposure or allergic flare-ups. I was really impressed with this work, which most people have forgotten. Regarding cats and the real but relatively rare risk of injection-site fibrosarcoma, we do not vaccinate indoor cats after their kitten and one more booster at 1-1.5 years. Typically, vets are changing recommendations for cats to booster every 3-5 years or, after 7-10 years of age, not at all. We no longer vaccinate any geriatric dogs, but do titers instead-for the reasons discussed earlier on this talk group. As far as new puppy owners, you might want to send along the articles on vaccinations from "the Whole Dog Journal". The December 2002 issue about titers etc is outstanding [but not because I was interviewed !!]. Jean Dear Giselle: You are all keeping me busy ! My two-finger typing hand is stiff ! Thuja is very useful to cleanse the body from vaccinosis. This plant is used whenever a reaction has occurred or if a puppy has had a mild reaction or is from a family predisposed to vaccine reactions. The kennel cough vaccine issue is a tough one. In high exposure risk situations like you describe, one has to balance the nuisance and aggravation when healthy dogs get kennel cough, with the potential for adverse effects. Yes, like any vaccine this one does produce some adverse effects. We prefer the intranasal version, but know of a minnie dachshund family where some members regularly collapse when given it (they can be revived). If the dogs in the household where fostering occurs have chronic disease or are immune compromised, they should receive kennel cough vaccine (Bordetella only, you don't need coronavirus vaccine). As coronavirus is readily killed at above 80 degrees, out of a draft, exposed dogs can be kept inside in a 80 degree room for 24-48 hrs and be fine. This virus typically causes disease in malnourished parasitized puppies that have parvovirus infection too. Hope this helps. Jean April 22, 2002, 12:32AM Pets don't need shots every year Experts say annual vaccines waste money, can be risky By LEIGH
HOPPER Debra Grierson leaves the veterinarian's office clutching Maddie and Beignet, her Yorkshire terriers, and a credit card receipt for nearly $400. That's the cost for the tiny dogs' annual exams, including heartworm checks, dental checks and a barrage of shots. "They're just like our children," said the Houston homemaker. "We would do anything, whatever they needed." What many pet owners don't know, researchers say, is that most yearly vaccines for dogs and cats are a waste of money -- and potentially deadly. Shots for the most important pet diseases last three to seven years, or longer, and annual shots put pets at greater risk of vaccine-related problems. The Texas Department of Health is holding public hearings to consider changing the yearly rabies shot requirement to once every three years. Thirty-three other states already have adopted a triennial rabies schedule. Texas A&M University's and most other veterinary schools now teach that most shots should be given every three years. "Veterinarians are charging customers $36 million a year for vaccinations that are not necessary," said Bob Rogers, a vet in Spring who adopted a reduced vaccine schedule. "Not only are these vaccines unnecessary, they're causing harm to pets." Just as humans don't need a measles shot every year, neither do dogs or cats need annual injections for illnesses such as parvo, distemper or kennel cough. Even rabies shots are effective for at least three years. The news has been slow to reach consumers, partly because few veterinarians outside academic settings are embracing the concept. Vaccine makers haven't done the studies needed to change vaccine labels. Vets, who charge $30 to $60 for yearly shots, are loath to defy vaccine label instructions and lose an important source of revenue. In addition, they worry their patients won't fare as well without yearly exams. "I know some vets feel threatened because they think, `People won't come back to my office if I don't have the vaccine as a carrot,' " said Alice Wolf, a professor of small-animal medicine at Texas A&M and an advocate of reduced vaccinations. "A yearly exam is very important." The movement to extend vaccine intervals is gaining ground because of growing evidence that vaccines themselves can trigger a fatal cancer in cats and a deadly blood disorder in dogs. Rogers conducts public seminars on the subject with evangelical zeal but thus far has been unsuccessful in persuading the Texas Veterinary Medical Association to adopt a formal policy. "I'm asking the Texas attorney general's office if this is theft by deception," said Rogers, whose Critter Fixer practice won an ethics award from the Better Business Bureau in 2000. "They just keep coming out with more vaccines that are unnecessary and don't work. Professors give seminars, and nobody comes and nobody changes." When rabies shots became common for pets in the 1950s, no one questioned the value of annual vaccination. Distemper, which kills 50 percent of victims, could be warded off with a shot. Parvovirus, which kills swiftly and gruesomely by causing a toxic proliferation of bacteria in the digestive system, was vanquished with a vaccine. Over the years, more and more shots were added to the schedule, preventing costly and potentially deadly disease in furry family members. Then animal doctors began noticing something ominous: rare instances of cancer in normal, healthy cats and an unusual immune reaction in dogs. The shots apparently caused feline fibrosarcoma, a grotesque tumor at the site of the shot, which is fatal if not discovered early and cut out completely. Dogs developed a vaccine-related disease in which the dog's body rejects its own blood. "That really caused people to ask the question, `If we can cause that kind of harm with a vaccine ... are we vaccinating too much?' " said Ronald Schultz, a veterinary immunologist at the University of Wisconsin School of Veterinary Medicine. "As you get more and more (vaccines), the possibility that a vaccine is going to cause an adverse event increases quite a bit." Less frequent vaccines could reduce that risk, Schultz reasoned. Having observed that humans got lifetime immunity from most of their childhood vaccines, Schultz applied the same logic to dogs. He vaccinated them for rabies, parvo, kennel cough and distemper and then exposed them to the disease-causing organisms after three, five and seven years. The animals remained healthy, validating his hunch. He continued his experiment by measuring antibody levels in the dogs' blood nine and 15 years after vaccination. He found the levels sufficient to prevent disease. Fredric Scott, professor emeritus at Cornell University College of Veterinary Medicine, obtained similar results comparing 15 vaccinated cats with 17 nonvaccinated cats. He found the cats' immunity lasted 7.5 years after vaccination. In 1998, the American Association of Feline Practitioners published guidelines based on Scott's work, recommending vaccines every three years. "The feeling of the AAFP is, cats that receive the vaccines every three years are as protected from those infections as they would be if they were vaccinated every year," said James Richards, director of the Feline Health Center at Cornell. "I'm one of many people who believe the evidence is really compelling." Texas A&M's Wolf said the three-year recommendation "is probably just as arbitrary as anything else," and nothing more than a "happy medium" between vaccine makers' recommendations and the findings by Schultz and Scott aimed at reducing vaccine-related problems. But many vets are uncomfortable making a drastic change in practice without data from large-scale studies to back them up. There is no animal equivalent of the U.S. Centers for Disease Control and Prevention, which monitors outbreaks of vaccine-preventable disease in people, thus keeping tabs on a vaccine's effectiveness. Federal authorities require vaccine makers to show only that a vaccine is effective for a reasonable amount of time, usually one year. Richards notes that studies to get a feline vaccine licensed in the first place are typically quite small, involving 25 to 30 cats at most. There is no federal requirement to show a vaccine's maximum duration of effectiveness. Arne Zislin, a veterinarian with Fort Dodge Animal Health, the largest animal vaccine maker in the world, said such studies would be expensive and possibly inhumane, requiring hundreds of animals, some of them kept in isolation for up to five years. "I don't think anyone with consideration for animals would really want to go through that process," said Zislin, another vet who believes current data are insufficient to support an extended schedule. Diane Wilkie, veterinarian at Rice Village Animal Hospital, said she tells pet owners that vaccines appear to last longer than a year, but her office hasn't officially changed its protocol yet. She said 20 percent to 30 percent of her cat patients are on the extended schedule. "It's kind of a hard situation. The manufacturers still recommend a year, but they're the manufacturers," Wilkie said. "It's hard to change a whole professional mentality -- although I do think it will change." In Houston, yearly pet examinations typically cost $50 to $135, with shots making up one-third to half of the expense. A dental check, heartworm test, fecal check and overall physical are usually included in the price. Without the shots, vets could expect to lose a chunk of that fee. But an increasing number of vets are emphasizing other services, such as surgery. Wolf said savings on vaccines might prompt pet owners to get their pets' teeth cleaned instead. An in-house test to check antibody levels is in development. "I definitely think there's a profit issue in there; don't get me wrong," Wilkie said. "(But) people are willing to spend money on their pets for diseases. Although vaccines are part of the profit, they aren't that big a part. We just did a $700 knee surgery."
Veterinary research challenges the notion that pets need to be vaccinated every 12 months. Some of the findings: Dog vaccines/Minimum duration of immunity
Cat vaccines/Minimum duration of immunity
Recommendations for dogs
Sources: Ronald Schultz, University of Wisconsin School of Veterinary Medicine; Fredric Scott, Cornell University College of Veterinary Medicine; Colorado State University; University of California-Davis Center for Companion Animal Health. |
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