I’ve never heard of a dog dying from a lepto vaccine, but I have heard of dogs dying of lepto.”
Four experts sat down with Adam Christman, DVM, MBA for a panel discussion on the current state of vaccinations and client education.
Content sponsored by Merck Animal Health
What vaccinations should veterinary professionals be administering and how can they best tackle patient concerns and hesitancy? Led by dvm360®’s Adam Christman, DVM, MBA, three clinicians and a professional dog breeder with a diverse range of experience and backgrounds convened for a panel discussion to address that question whose answer is always evolving. The group discussed their current approach to vaccine protocols for various diseases, including canine respiratory disease, leptospirosis, rabies, and more.
Commonly referred to as kennel cough, CIRDC can be caused by one or a combination of several pathogens. The panel discussed a well-known threat in Bordetella bronchiseptica, as well as the more-recently emerging spread of parainfluenza and canine adenovirus.
“We know that the coughing dog, especially the upper respiratory infection in a dog, is not usually single pathogen,” said Jenifer Chatfield, DVM, DACZM, DACVPM. “It’s a multipathogenic infection, so while culture may reward the bacteria that outgrows everybody else and point the finger at that single pathogen, I think typically what we’re looking at is kind of a mixed bag.”
Chatfield later added, “[That’s why] almost every [canine] patient I see gets an upper respiratory vaccination, but I don’t vaccinate only for Bordetella. I prefer to use the intranasal vaccine, because it has 3 components to it. It’s not just vaccinating for Bordetella because in my experience Bordetella is very rarely the problem…We know parainfluenza is kind of the glue that holds the infectious disease complex together in dogs, and so I like to vaccinate for parainfluenza. I like to vaccinate for Bordetella and also canine adenovirus, and that’s all contained in that intranasal vaccination.”
Yasmine Mortsakis, DVM, shared her experience in Manhattan and the lifestyle of city dogs that live in high-population-density areas: “Some [dogs] go to daycare; maybe some don’t; maybe some go to the park; some don’t. [However,] for the dogs that come into the facility, often we’re still recommending every 6 months for that intranasal Bordetella [vaccine] because the efficacy does wane at 8 months, and we’re talking about a high-risk population.
Mortsakis continued, “I think you need to vaccinate against as much as you can…We want these dogs to be playing and having a healthy time.”
Chatfield remarked, “Well, there’s so many things we can’t vaccinate against, right? So, let’s do what we can do…[Let’s] treat for the treatable.”
In her experience as a breeder of Siberian huskies with Ninkasi Siberians, Laura Anderson commented on the protocols for her particular situation: “Part of it is also environmental control at my house, because I have senior dogs that are running 14 to 15 years old. Because I’m taking these dogs out to shows and environments where there’s a lot of dogs, I actually have sections of my home, [that are] isolated [and] on completely different ventilation…to prevent exposures to the senior dog.”
On vaccine schedules, Anderson takes great responsibility in making sure her dogs are vaccinated before a show to ensure the efficacy is at its highest when risk is at its highest. “If I’m doing something once a year, that’s not going to be enough if my high-risk show ends up being 11 months down the road,” Anderson said.
“We actually had a very bad outbreak in Manhattan and a lot of dogs were affected. There were dogs that ended up with pneumonia, [and some even passed away], said Mortsakis. She continued, “If you’re waiting until an outbreak happens, it’s too late to be vaccinating…"
Primm put a bow on the discussion, commenting, “Vaccination is safe and inexpensive on the scale of things. If you’ve had to treat a pneumonia, it’s certainly less expensive than that. So why not, right?”
Leptospirosis is a bacterial disease found worldwide in soil and water. Chatfield said, “If anyone ever asks [if you have lepto in your area,] your answer is, ‘Yes we do, at all times.’” According to Chatfield, the threat of leptospirosis is on the rise: “In the United States, it’s considered a reemerging pathogen, because we’re starting to see a trend and an uptick of cases in humans and in pets.”
Primm said she capitalizes on the fact that leptospirosis is zoonotic in order to motivate clients to accept the vaccine for their pets. She said, “When I go into the exam rooms to talk with pet owners, I always mention, 'I want to vaccinate your dog for this…and the fact that I want to protect you and your family too… your dog is definitely drinking out of puddles, and your yard has squirrels. And in Tennessee, your yard has possums and raccoons, too.'"
Mortsakis added that in addition to increasing rat and dog populations in urban environments, there has been less of a push for leptospirosis vaccines because of the misconception that an infection requires a substantial amount of water. She commented, "We think about puddles of water and things like that, but it doesn’t have to be some ginormous puddle of water. It could be little bit of water on the street and a dog sniffs that. It’s mucous membranes, right? So, it’s not just that they’re drinking it. It can go in through the nose. [Infection can also occur if] there’s a little cut on the bottom of the paw and they just happen to walk through a little bit of urine. And again, there are asymptomatic dogs that are shedding it, as well."
Primm commented on the improvement of the leptospirosis vaccines over the years and the concerns of anaphylactic reactions: “In the olden days, when I first graduated from veterinary school, lepto vaccines were not as good. I remember seeing a lot of puffed-up faces, and it sort of stood out to me as a baby vet…Now the vaccines are just so much better, and I think it’s because of things like VacciPure™, because it filters out some of the proteins and some of the things that are stimulating bad [reactions]. I want to knock on wood, but I haven’t seen a vaccine reaction in a really long time from any of my vaccines, because I use all the really pure ones and the best that’s available.”
When Chatfield mentioned the 40% mortality rate of the hepatic version of leptospirosis, Primm asked rhetorically, “That’s my question: Why wouldn’t you vaccinate for it?”
“I didn’t realize there was a hepatic version of lepto,” said Anderson. “If you have a 40% mortality rate…that’s really, really scary stuff.”
Anderson concluded, “I’ve never heard of a dog dying from a lepto vaccine, but I have heard of dogs dying of lepto.”
On flea preventive treatments, both Chatfield and Mortsakis both recommended using a product that lasts 3 months vs 1, saying it’s easier for clients to follow a schedule with fewer doses. Chatfield added, “The data shows that even if you give shorter-acting ones on the exact same day at the exact right time, and you calculate it out, you still see that dip in efficacy. And so I just give [the longer-acting medication] and don’t worry about it.”
Anderson outlined her client education strategy around vaccines and preventives: “Every person who gets a puppy from me has to listen to my speech about healthcare, and they go home with a document that outlines [the treatment plan]. They don’t just read it; they listen to me talk through it.”
Mortsakis added: “It’s a lot of information that we’re giving them all at once and their heads sort of start spinning off. What we found was really helpful is we send a follow up email to them, and it actually tailors the vaccine schedule for [their pet]. Then there’s a little blurb about, just in case they forgot, about what each vaccine is for, why it’s important, and what the exposure risks are…We’ve seen that’s helped a lot with compliance and understanding what we’re talking about, because they do leave sort of overwhelmed and kind of deer-in-headlights.”
Primm shared: “I love client education, and I like to do handouts and train my team. I wrote some client education handouts for dvm360®, and one of them was: “Why do many pets need vaccines?” It’s a single-page handout, and we include that in our puppy package.”
The group wrapped up the discussion with a focus on feline-specific issues. They addressed the fact that because many pet parents view their cats as indoor pets, convincing them to get the appropriate preventive car can be a challenge.
Chatfield shared the conversation she has with pet parents on getting their cat vaccinated for rabies: “We vaccinate for the rabies exposure we don’t know about…If you don’t know that the one time they got out they encountered a raccoon that was rabid, you don’t know to boost it, right? [That’s why] it’s better to have them routinely vaccinated.”
Mortsakis added that her strategy when speaking with cat-parent clients who also own dogs is to tell them: “Your cat really isn’t indoor solely, because your dog’s not indoor solely.” She said that this tact can help clients see the need for heartworm and flea and tick prevention.
On flea prevention, the group discussed the benefits of using a longer-acting medication. They agreed that between topical and chewable forms, it helps to have options to individualize the treatment to the cat and owner’s needs and preferences.
Chatfield said, “Putting anything topical on a cat that wasn’t their idea, and it will never be their idea...[it’s better] if I only have to do that every 3 months or [so]. She added, “People can’t imagine doing it once a month and I [tell them], ‘Oh, no, it’s not that often. It’s just, 4 times a year.’ That sounds better.”