Clients refusal to vaccinate puts herself, veterinary team at risk

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Possible exposure to rabies is not something to take lightly.

I couldn't disagree more strongly with Marc Rosenberg's December column “Safety-or client's preference-first?” I try to tailor vaccination recommendations and administration to individual patents, to neither under- nor overvaccinate. But rabies vaccination is legislated, not primarily for animal health but for human health. Cats need to be vaccinated against rabies, even if they're kept inside.

That cats are probably “dead-end hosts” and not an actual threat to humans is a moot point. When an infinitesimal chance of rabies exposure is suspected, tens of thousands of dollars will be spent (and in the case of cats, wasted) on testing for people exposed only by imagination! Other pets may be euthanized and there are legal liability issues-it's a nightmare for the pet, the client and the veterinarian-so the veterinarian can and should have a say in the decision.

Although it's highly unlikely that a pet would get exposed to rabies in an animal hospital, the same cannot be said for other infectious diseases. More and more pediatric practices are refusing to care for children whose parents refuse “core” vaccinations. If I see an animal in an exam room that is not properly vaccinated against rabies or an unvaccinated young animal that is at risk for distemper, parvovirus or upper respiratory infection and the client refuses vaccination, I take care of the pet and the problem at hand and inform the client I will not see the pet again unless it has been vaccinated (unless I decide there is a medical contraindication). But if the pet needs to be hospitalized, I refuse to do so without permission to vaccinate.

When so many veterinarians now refuse to do even simple, safe procedures without hundreds of dollars' worth of lab work or refuse to euthanize a vicious dog because it is healthy, I fail to understand a reluctance to insist on minimal vaccination. Whlie the client has the right to accept or decline the protocol recommended or required by the veterinarian, the veterinarian also has the right to decide how to handle clients who do not accept that protocol.

One final comment: I can't imagine considering the client described as an excellent client who comes in routinely. In my experience, the person described only comes in when desperate, argues every recommendation and rarely follows the recommendations of any mainstream professional.

Patricia Burke, DVM

Providence, Rhode Island

I don't know the laws in New Jersey, but in many states there are laws concerning possible exposure of pets to wild animals. Tuffy went out of the house and came back with a laceration. Where did it come from? Could Tuffy have tangled with a rabid skunk or raccoon? We can't rule out that possibility. In my state, animal control officers would be notified and apprised of the situation. The ethics problem as described here would increase significantly if Tuffy were taken care of by the veterinarian, showed odd behavior a few months later, and bit his owner-who would then be at risk of contracting rabies.

Personally, I have an inflexible policy on rabies vaccinations. All cats and dogs over the age of 4 months are required by Virginia law to be vaccinated for rabies, and I insist on it. If a client turns down a distemper or feline leukemia vaccination, the worst thing that happens is that the pet dies. But if a rabies vaccination is declined, a client could be put at genuine risk. I would not want that on my conscience.

Ruth E. Chodrow, VMD

Fishersville, Virginia

I do agree with Dr. Rosenberg. While I respect the decision of the team members who declined to assist in treating Tuffy, I would have been one who assisted the doctor in this situation. And I would have used gloves and a towel to wrap the cat in for sedation.

The owner, while a good client, is foolish not to vaccinate her cat, especially for rabies, and I think Dr. Summer acted most appropriately in insisting Tuffy be vaccinated. Rabies is deadly, and treatment is expensive and may not work after symptoms appear. Not even an excellent client is worth the risk. However, no one could know if Tuffy had come in contact with a rabid animal while out where he got hurt. In my area, rabies is rare and found primarily in the bat population, thus lessening the chance of infection through a laceration. If Tuffy had been playing with a bat when he got hurt, it would have been a much different scenario.

Ila Fetterly, CVT

Rainier, Oregon

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