Friday, January 6, 2012

Changing vaccine protocols

Or alternatively, how the last generation of veterinarians messed up.  

Vaccines are great, they save lives, keep pets and in some instances their owners safe and healthy.  But the way we use them is changing.  It is commonly recognized (well, by those of us that pursue continuing education) that not all pets need all vaccines every year.  Vaccinating annually for "everything" has been common practice for years.  That wasn't necessarily wrong-after all it worked-pets were no longer getting the multitude of diseases they used to die from,  immunity from the vaccines seem to last a year, and it was a convenient interval at which to examine the pet and give the "shots."  But times change, we learn about risks, benefits, and side effects.  It's no different than any other medical practice like anesthesia, antibiotic use, pain management and more.

So where did veterinarians mess up?  By emphasizing the importance of the vaccines and downplaying the importance of the annual exam.  It was, and still is, in many clinics common practice to include the exam in the price of the vaccines, perform a free exam, or even neglect to do a thorough exam altogether.  So now, just as in all other facets of medicine we know more about vaccines.  We know that although very safe, they are not totally benign and can be responsible for unwanted reactions.  We also know that duration of immunity is longer than 1 year for many diseases.  At least 3 years for some and possibly much longer but no one wants to fund those studies.  

So now we have a situation where those veterinarians who want to keep up with quality medical care are extending some vaccine intervals to 3 years.  But clients have been told for years that their pet needs to come in when he is due for "shots" and so many of them don't see the need to come in if their pet is not due for vaccines.  

This is an unfortunate situation for those pets that don't get seen more than every three years.  Many things can change in 3 years.  I can't tell you how many "healthy" pets come in for vaccines and have ear infections, dental disease, arthritis, fleas, etc.  that their owners have not noticed.  In addition to this some vaccines don't last for 3 years.  So if your pet is at risk for these and your vet is not tailoring vaccine protocols to your pet then they may be unprotected.  Also there is annual parasite testing such as heartworm tests and fecal exams depending on where you live and your pet's lifestyle.  But the importance of these has also not been emphasized as they should be. If an owner does not understand the importance of examinations and parasite control they are very likely to let these things lapse since the pet is not due for vaccines.  Honestly, if an adult dog comes in and the owner financially needs to choose between vaccines and heartworm testing and prevention I would rather they do the heartworm.  They are much more at risk for this than parvo!  But getting yearly "shots" is so ingrained in people that it's hard to convince them otherwise.  It's an uphill battle for the next generation of veterinarians.  Many clinics in my area still do annual vaccines.  I have not always even agreed with the vaccine protocol of clinics I have worked at in the past or currently.  But, I don't own any of the practices and many owners are unwilling to take this financial gamble of retraining clients and earning revenue from services other than vaccines.  If a client has a particular vaccine request I am happy to oblige and help them determine the best vaccination plan for their pet.  

So what do I do for my pets and why? For the dogs I do DHPP every 3 years (roughly).  Probably they don't need it this often but it's what is currently recommended and I feel the risk of vaccination is low especially as none of my dogs have ever had any reactions.  As long as I can get a vaccine without corona I skip that one.  Corona is a mild and self limiting diarrhea of puppies and that vaccine is now on the not-recommended list.  I do vaccinate all my dogs annually for Lepto.  This is a disease we see occasionally, can be fatal and also can be transmitted to people and the immunity is typically a year or less.  The vaccine is not perfect-only protects against a max of four strains but better than nothing.  I also vaccinate annually for Bordetella.  This vaccine may only last closer to six months but I don't feel my dogs are at super high risk.  Even though they go to dog shows those are typically other well cared for house pets, not stray dogs at the pound, running the neighborhood, etc.  Plus I see lots of vaccinated dogs that have "kennel cough" like signs so it obviously does not protect against all pathogens.  Finally I vaccinate for Rabies according to law-which here is every 2 years.

The house cats get Rabies per law or per label (if I am using the special "cat" vaccine it's only labeled for 1 year) and FVRCP every 3 years (probably they don't really need this being in the house but that is the current recommendation and I feel with the newer cat products risk is pretty minimal).  The barn cats get Rabies per law/label and FVRCP every three years.  They also get feline leukemia vaccines annually.  Some will say that after the first annual booster they are immune to leukemia for life but other studies showed variable immunity that did not last 3 years.  Since this disease is uniformly fatal I elect to give it to those guys annually.  

I'm not sure that was as educational as it was an inside look at the changing face of vet med but hopefully some of you found it interesting nonetheless.


Border Collie Mom said...

Nicki- Thanks for sharing your thoughts on this. I'll share a view "from the other side" as well. As you might know, I have a 17 year old at home and I'm late for her yearly exam because I know that I will have to argue with the vets over her vaccines. She has been vaccinated for 16 years and I think that she has probably built up some immunity by now and can 'skip' a year for some of them. She is also pretty housebound, so I don't worry too much about lepto. I would already have had her in for a yearly exam if I knew I would not have to argue this point.

Sue said...

This is a tough topic that I give a lot of thought. The younger dogs get vaccines every two years now. The older ones every three years. I'm also starting Lepto this year since we're in the country and have nocturnal visitors who could be carriers.

Samba is my biggest concern. I've decided to go with a three year schedule with her but to schedule her vaccinations separately so she isn't overloaded at once. Her immune system seems to be improving and we're going to try to reduce her pred again soon. Wish us luck.

Nicki said...

That's too bad that your vet is not more realistic about the need to vaccinate a 17 year old dog. Good luck.

Cedarfield said...

Thanks for sharing your views on this. It can be difficult to known what's best to do nowadays, especially when you get different recommendations from different vets in the same practice.