February 3, 2012

Vaccines

You probably vaccinate your pets, as most responsible owners do. What you may not know is that over-vaccination can be extremely harmful to your pet at worst, and at best it's a waste of money. What do you need to know about vaccines? What vaccines do you actually need to give your puppy? When should you vaccinate your puppy? What about boosters? I'll cover all of it.

I'm going to quote information from veterinarians and research, not put this in my own words. Some of it has been slightly reformatted to be easier to read. I'll first bombard you with common abbreviations concerning vaccines, from the 2011 AAHA Canine Vaccination Guidelines (more from those guidelines later):

Bb = Bordetella bronchiseptica [aka "kennel cough"]
CAV-1 = canine adenovirus, type 1(cause of canine viral hepatitis)
CAV-2 = canine adenovirus, type 2
CCoV = canine coronavirus
CDV = canine distemper virus
CIV = canine influenza virus—H3N8
CPiV = canine parainfluenza virus
CPV-2 = canine parvovirus, type 2
DOI = duration of immunity
IM = intramuscular (route of administration) [into the muscle]
IN = intranasal or mucosal (route of administration) [into the nasal passage]
MDA = maternally derived antibody
MLV = modified live virus, attenuated virus vaccine
MV = measles virus
RV = rabies virus
SQ = subcutaneous (route of administration) [under the skin]
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First, a basic understanding of how vaccines work. Dr. Jean Dodds says, "There are two types of vaccines currently available to veterinarians: modified-live vaccines and inactivated ("killed") vaccines." Explained below by Dr. Dodds:

Modified Live Vaccines (MLV)

Modified-live vaccines contain a weakened strain of the disease causing agent. Weakening of the agent is typically accomplished by chemical means or by genetic engineering. These vaccines replicate within the host, thus increasing the amount of material available for provoking an immune response without inducing clinical illness. This provocation primes the immune system to mount a vigorous response if the disease causing agent is ever introduced to the animal. Further, the immunity provided by a modified-live vaccine develops rather swiftly and since they mimic infection with the actual disease agent, it provides the best immune response. 

Inactivated Vaccines (Killed)
Inactivated vaccines contain killed disease causing agents. Since the agent is killed, it is much more stable and has a longer shelf life, there is no possibility that they will revert to a virulent form, and they never spread from the vaccinated host to other animals. They are also safe for use in pregnant animals (a developing fetus may be susceptible to damage by some of the disease agents, even though attenuated, present in modified-live vaccines). Although more than a single dose of vaccine is always required and the duration of immunity is generally shorter, inactivated vaccines are regaining importance in this age of retrovirus and herpesvirus infections and concern about the safety of genetically modified microorganisms. Inactivated vaccines available for use in dogs include rabies, canine parvovirus, canine coronavirus, etc.

Dr. Jean Dodds' Recommended Vaccination Schedule

1. Distemper (CDV) (MLV)
*Initial vaccine (e.g. Intervet Progard Puppy) given at 9 weeks, 12 weeks, and 16 - 20 weeks.
*1st Annual Booster given at 1 year - MLV Distemper/Parvovirus only
*Re-Administration Interval: None needed.
*Duration of immunity 7.5 / 15 years by studies. Probably lifetime. *Longer studies pending.
*Comments: Can have numerous side effects if given too young (< 8 weeks).

2. Parvovirus (CPV) (MLV)
*Initial vaccine (e.g. Intervet Progard Puppy) given at 9 weeks, 12 weeks, and 16 - 20 weeks
*1st Annual Booster given at 1 year MLV Distemper/Parvovirus only
*Re-Administration Interval: None needed.
*Duration of immunity 7.5 years by studies. Probably lifetime. *Longer studies pending.
*Comments: At 6 weeks of age, only 30% of puppies are protected but 100% are exposed to the virus at the vet clinic.

3. Rabies (killed)
*Initial vaccine given at 24 weeks [~6 months] or older
*1st Annual Booster given at 1 year (give 3-4 weeks apart from Dist/Parvo booster), killed 3 year rabies vaccine
*Re-Administration Interval: 3 yr. vaccine given as required by law in California (follow your state/provincial requirements)
*Comments: rabid animals may infect dogs.
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And that's it! Those are the only 3 vaccines recommended by Dr. Jean Dodds, at those specific ages. These are usually referred to as the "core" vaccines. Here are other vaccines commonly given that are not needed, called "non-core" vaccines. Do research in your own area to determine if your dog would actually benefit from any these vaccines, paying attention to the side effects and consequences of these vaccines as well as variations of the vaccines to make sure your dog receives the right one if you deem it necessary.



Vaccines Not Recommended For Dogs

1. Distemper & Parvo @ 6 weeks or younger
*Not recommended.
*At this age, maternal antibodies form the mothers milk (colostrum) will neutralize the vaccine and only 30% for puppies will be protected. 100% will be exposed to the virus at the vet clinic.

2. Corona
*Not recommended.
1.) Disease only affects dogs <6 weeks of age.
2.) Rare disease: TAMU has seen only one case in seven years.
3.) Mild self-limiting disease.
4.) Efficacy of the vaccine is questionable.

*Leptospirosis
*Not recommended
1) There are an average of 12 cases reported annually in California.
2) Side effects common.
3) Most commonly used vaccine contains the wrong serovars. (There is no cross-protection of serovars) There is a new vaccine with 2 new serovars. Two vaccinations twice per year would be required for protection.).
4) Risk outweighs benefits.

*Lyme
*Not recommended
1) Low risk in California.
2) 85% of cases are in 9 New England states and Wisconsin.
3) Possible side effect of polyarthritis from whole cell bacterin.

*Bordetella (Intranasal) (killed)
*Only recommended 3 days prior to boarding when required.
*Protects against 2 of the possible 8 causes of kennel cough.
*Duration of immunity 6 months.

*Giardia
*Not recommended
*Efficacy of vaccine unsubstantiated by independent studies
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So why is distemper, parvo, and rabies recommended to be given at certain ages? Dr. Dodds continues:

Immunization Schedules
There is a great deal of controversy and confusion surrounding the appropriate immunization schedule, especially with the availability of modified-live vaccines and breeders who have experienced postvaccinal problems when using some of these vaccines. It is also important to not begin a vaccination program while maternal antibodies are still active and present in the puppy from the mother's colostrum. The maternal antibodies identify the vaccines as infectious organisms and destroy them before they can stimulate an immune response.


A note from Dr. Dodds:
Note: This schedule is the one I recommend and should not be interpreted to mean that other protocols recommended by a veterinarian would be less satisfactory. It's a matter of professional judgment and choice. For breeds or families of dogs susceptible to or affected with immune dysfunction, immune-mediated disease, immune-reactions associated with vaccinations, or autoimmune endocrine disease (e.g., thyroiditis, Addison's or Cushing's disease, diabetes, etc.) the above protocol is recommended.
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You may be concerned that your dog is actually not immune by only giving those vaccines when the dog is a puppy. Fear not, immunity can be tested for! Titer testing is explained by the National Institutes of Health (NIH): "Antibody titer is a laboratory test that measures the presence and amount of antibodies in blood. The antibody level in the blood is a reflection of past exposure to an antigen or to something that the body does not recognize as belonging to itself. The body uses antibodies to attack and remove foreign substances."

Dr. Dodds goes on:

Titer Testing
After 1 year, annually measure serum antibody titers against specific canine infectious agents such as distemper and parvovirus. This is especially recommended for animals previously experiencing adverse vaccine reactions or breeds at higher risk for such reactions (e.g., Weimaraner, Akita, American Eskimo, Great Dane).

Another alternative to booster vaccinations is homeopathic nosodes. This option is considered an unconventional treatment that has not been scientifically proven to be efficacious. One controlled parvovirus nosode study did not adequately protect puppies under challenged conditions. However, data from Europe and clinical experience in North America support its use. If veterinarians choose to use homeopathic nosodes, their clients should be provided with an appropriate disclaimer and written informed consent should be obtained.

I use only killed 3 year rabies vaccine for adults and give it separated from other vaccines by 3-4 weeks. In some states, they may be able to give titer test result in lieu of booster.

I do NOT use Bordetella, corona virus, leptospirosis or Lyme vaccines unless these diseases are endemic in the local area pr specific kennel. Furthermore, the currently licensed leptospira bacterins do not contain the serovars causing the majority of clinical leptospirosis today.

I do NOT recommend vaccinating bitches during estrus, pregnancy or lactation.

W. Jean Dodds, DVM
HEMOPET
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Now, a Q&A from Dr. Dodds:
Some Frequently Asked Questions – Some questions are part of the Guidelines for Vaccination of Dogs and Cats compiled by the Vaccine Guidelines Group (VGG) of the World Small Animal Veterinary Association (WSAVA)

Q. Do dogs competing in agility or other events need more vaccines for protection than other pet dogs?
A.
No, although if the event location has an exposure risk for Leptospirosis or Lyme disease , annual vaccination for these diseases should be considered.

Q. Is there risk of overvaccinating with vaccines not needed for a specific animal?
A.
Yes. Vaccines contain material designed to challenge the immune system of the pet, and so can cause adverse reactions. They should not be given needlessly, and should be tailered to the pet’s individual needs.

Q. Are the initial series of puppy core vaccines immunosuppressive?
A.
Yes. This period of immunosuppression from MLV canine distemper and hepatitis vaccines coincides with the time of vaccine-induced viremia, from days 3 to 10 after vaccination.

Q. Can anesthetized patients be vaccinated?
A.
This is not preferred, because a hypersensitivity reaction with vomiting and aspiration could occur and anesthetic agents can be immunomodulating.

Q. Is it safe to vaccinate pregnant pets?
A.
Absolutely not.

Q. Should pets with immunosuppressive diseases such as cancer or autoimmune diseases, or adverse vaccine reactions/ hypersensitibvity receive booster vaccinations?
A.
No. Vaccination with MLV products should be avoided as the vaccine virus may cause disease; vaccination with killed products may aggravate the immune-mediated disease or be ineffective. For rabies boosters that are due, local authorities may accept titers instead or accept a letter from your veterinarian.

Q. If an animal receives immunosuppressive therapy, how long afterwards can the pet safely be vaccinated?
A.
Wait at least 2 weeks.

Q. Should vaccines be given more often than 2 weeks apart even if a different vaccine is being given?
A.
No. The safest and most effective interval is 3-4 weeks apart.

Q. At what age should the last vaccine dose be given in the puppy series?
A.
The last dose of vaccine should be given between 14-16 weeks regardless of the number of doses given prior to this age. Rabies vaccine should preferably be given separately as late as possible under the law (e.g. 16-24 weeks).

Q. Should the new canine influenza vaccine be given routinely?
A.
No. It is intended primarily for pounds and shelters and high density boarding facilities, as nose-to-nose contact and crowding promote viral transmission.

Q. Can intranasal Bordetella vaccine be given parenterally (injected)?
A.
No. The vaccine can cause a severe local reaction and may even kill the pet.

Q. Will a killed parenteral Bordetella vaccine given intranasally produce immunity?
A.
No.

Q. Are homeopathic nosodes capable of immunizing pets?
A.
No. There is no scientific documentation that nosodes protect against infectious diseases of pets. The one parvovirus nosode trial conducted years ago did not protect against challenge.

Q. Should disinfectant be used at the vaccine injection site?
A.
No. Disinfectants could inactivate a MLV product.

Q. Can vaccines cause autoimmune diseases?
A.
Vaccines themselves do not cause these diseases, but they can trigger autoimmune responses followed by disease in genetically predisposed animals, as can any infection, drug, or chemical / toxic exposures etc.

Q. Can a single vaccine dose provide any benefit to the dog? Will it benefit the canine population?
A.
Yes. One dose of a MLV canine core vaccine should provide long term immunity when given to animals at or after 16 weeks of age. Every puppy 16 weeks of age or older should receive at least one dose of the MLV core vaccines. We need to vaccinate more animals in the population with core vaccines to achieve herd immunity and thereby prevent epidemic outbreaks.

Q. If an animal receives only the first dose of a vaccine that needs two doses to immunize, will it have immunity?
A.
No. A single dose of a two-dose vaccine like Leptospirosis vaccine will not provide immunity. The first dose is for priming the immune system. The second for boosting the immunity has to be given within 6 weeks; otherwise the series has to start over again. After those two doses, revaccination with a single dose can be done at any time.

Q. Can maternally derived antibodies (MDA) also block immunity to killed vaccines and prevent active immunization with MLV vaccines?
A.
Yes. MDA can block certain killed vaccines, especially those that require two doses to immunize. With MLV vaccines, two doses are often recommended, particularly in young animals, to be sure one is given beyond the neutralizing period of MDA. 

Q. How long after vaccination does an animal develop immunity that will prevent severe disease when the core vaccines are used?
A.
This is dependent on the animal, the vaccine, and the disease.

· The fastest immunity is provided by canine distemper virus (CDV) vaccines -- MLV and recombinant canarypox virus vectored. The immune response starts within mins - hrs and provides protection within a day without interference from MDA.
· Immunity to canine parvovirus (CPV-2) develops after 3-5 days when an effective MLV vaccine is used.
· Canine adenovirus-2/hepatitis (CAV-2) MLV given parenterally provides immunity against CAV-1 in 5 to 7 days.

Q. Can dogs be “non-responders” and fail to develop an immune response to vaccines?
A
Yes. This is a genetic characteristic seen particularly in some breeds or dog families. Boosting them regularly will not produce measurable antibody. Some of these animals may be protected against disease by their cell-mediated and secretory immunity.

Q. Are there parvovirus and distemper virus field mutants that are not adequately protected by current MLV vaccines?
A.
No. All the current CPV-2 and CDV vaccines provide protection from all known viral isolates, when tested experimentally as well as in the field. The current CPV-2 and CPV-2b vaccines provide both short and long term protection from challenge by the CPV-2c variant.

Q. Are serum antibody titres useful in determining vaccine immunity?
A.
Yes. They are especially useful for CDV, CPV-2 and CAV-1 in the dog, FPV in the cat, and rabies virus in the cat and dog. Rabies titers, however, are often not acceptable to exempt individual animals from mandated rabies boosters in spite of medical justifcation. Serum antibody titers are of limited or no value for (many of) the other vaccines.
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Now, some information from the American Animal Hospital Association (AAHA). I'm going to copy and paste, you can find the entire 42 page guidelines in .pdf format here.


2011 AAHA Canine Vaccination Guidelines
p. 3 "When compared with infectious (attenuated, avirulent, modified live, recombinant viral vectored) vaccines, noninfectious vaccines are more likely to produce local and systemic adverse reactions in some dogs."

p.10 "Most noninfectious vaccines require at least two initial doses to immunize, regardless of the dog's age. The first does of a noninfectious vaccine generally primes the immune response and the second dose, which should be administered 2-6 weeks later, provides the protective immune response. Immunity typically develops approximately 7 days after the second dose. Therefore, the minimum time for onset of immunity is approximately 3 wk after administration of the first dose of a noninfectious vaccine"

p. 12 "Because dogs older than 14-16 wk of age are not likely to have interfering levels of MDA [maternally derived antibodies], administration of a single initial dose of an infectious vaccine to an adult dog can be expected to induce a protective immune response. ..... MDA is the most common reason early vaccination fails to immunize."

p. 12 "The onset of immunity after administration of a single dose of infectious core vaccine is approximately 4+3 days in the absence of MDA [maternally derived antibodies]."

p.13 "Infectious core vaccines are not only highly effective, they also provide the longest DOI [duration of immunity], extending from 5 yr up to the life of the dog."

p. 17 "Despite the confusion and controversy surrounding antibody testing, these serologic tests are useful for monitoring immunity to CDV, CPV-2, CAV-1, and RV. .....On completion of the puppy core vaccination series with the last dose given at 14-16 wk of age, a dog can be expected to have an antibody titer or positive test result, regardless of the serologic test performed, provided the serum sample is collected > 2 wk after the last dose of vaccine." (CDV=distemper, CPV-2 = parvovirus, CAV-1 hepatitis, RV= rabies)

p. 18 "....the last dose of CDV and CPV should be administered at 14-16 wk of age. At this age, MDA should be at a level that will not block active immunity in most puppies (>98%) when a combination MLV vaccine is administered."

p. 18 "In a study reported in 1997, dogs vaccinated with a product containing CDV (canine distemper virus) and then placed in an environment without CDV maintained antibody titers for at least 10 yr."

p. 20 "...the list that follows includes categories of adverse reactions that have been attributed to vaccine administration.
-Injection-site reactions: lumps (abscess, granuloma, seroma), pain, swelling, hair loss associated with ischemic vasculitis

-Transient postvaccinal nonspecific illness: lethargy, anorexia, fever, regional lymphadenomegaly, soreness, abortion, encephalitis, polyneuritis, arthritis, seizures, behavioral changes, hair loss or color change at the injection site, respiratory disease

-Allergic (hypersensitivity) and immune-mediated reactions:
Type 1 (acute anaphylaxis): angiodema (especially the head), anaphylaxis (shock) and death
Type 2 (cytolytic): immune-mediated hemolytic anemia, immune-mediated thrombocytopenia (suspected only; causality has not been confirmed)
Type 3 (immune-complex): cutaneous ischemic vasculopathy associated with rabies vaccine, corneal edema ('blue-eye') associated with CAV-1 vaccine, immune-mediated disease.

-Tumorigenesis: vaccine-associated sarcoma or other tumors

-Multisystemic infectious/inflammatory disorder of young Weimaraner dogs: may be genetically linked to both a poorly characterized immunodeficiency and to autoimmune disorders (e.g., hypothyroidism and hypertrophic osteodystrophy [HOD] that are detected shortly after vaccination

-Vaccine-induced immunosuppression: associated with first or second dose of combination MLV vaccines containing CDV and CAV-1 or CAV-2 with or without other vaccines (e.g., CPV-2, CPI). Immunosuppression begins 3 days after vaccination and persists for 7-10 days. The suppression may be associated with increased susceptibility to other diseases.

p. 21 "It is reasonable to avoid administration of any vaccine to patients with a history of systemic disease suspected to be associated with previous vaccination (e.g., immune-mediated hemolytic anemia, immune-mediated thrombocytopenia) or known to be caused by vaccine (vaccination-site cutaneous ischemic vasculitis after administration of rabies vaccine).

p. 28 "As with pregnant dogs, veterinary medicine has advised against vaccination during illness, due to concerns about suboptimal protection, or worse, vaccine-induced illness."

p. 29 "Manufacturers only recommend administration of vaccine to healthy dogs. Dogs receiving immunosuppressive chemotherapy should not be vaccinated. Doing so may result in a suboptimal immune response or may aggravate (reactivate) an immune-mediated illness."

p.33 "Vaccine adverse events are significantly underreported in veterinary medicine."

p. 34 "The vaccination protocol that includes the minimum number of vaccines yet still provides a reasonable opportunity to immunize the dog would be: a single dose of combined infectious (attenuated, avirulent, modified live, recombinant viral vectored) CDV, MLV CPV-2, with MLV CAV-2, administered at 16 wk of age or older, plus a rabies shot at the same time (but inoculated at a separate site on the body)." 
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You feel like a pro now when it comes to vaccines? Or simply overwhelmed? It boils down very simply for me. I follow Dr. Jean Dodds' recommendations and only vaccinate my dogs with the 3 core vaccines. Two or three rounds of parvo and distemper at the specific ages as puppies, rabies at 6 months, titers for parvo and distemper at 1 year, then rabies every 3 years after that or as required by law. Titer testing once every several years to verify immunity. That's it!

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