Primed for protocols

As the American Animal Hospital Association (AAHA) prepares to roll out its canine vaccine guidelines advocating less frequent administration, veterinarians, like Dr. Mark Epstein, say reports such as this are long overdue.

Epstein, who modified his vaccination protocols five years ago, sayshe's been waiting for the profession to catch up.

"I wish the guidelines had been published earlier because it'd beeasier for me to defend the way I do things," he says. "Now theguidelines put everybody on the same boat. They take a stand on better waysto be thinking about preventive healthcare."

The canine-specific guidelines arrive at a time when the profession isbeing flooded with discussions of vaccination frequency and duration ofimmunity, prompted in part by reports from other leading professional groups.

Late last year, the American Veterinary Medical Association (AVMA), viaits Council on Biologic and Therapeutic Agents, released updated generalcanine and feline vaccine guidelines. Four years earlier, the American Associationof Feline Practitioners issued a report specific to feline vaccine protocols.

That's why Dr. Margaret Rucker, former president of AAHA, says the latestguidelines left no surprises.

"After the release of the feline guidelines, there was no reasonto think dogs would be any different. If you're paying attention, you shouldrealize this was coming down the pike," Rucker says.

For Dr. Lorraine Jarboe, the only surprise was that AAHA lagged behindAVMA in publishing.

The incoming president of the American Board of Veterinary Practitionersadds, "I really don't think there's any controversy. There's not enoughevidence for them to come out with anything more definitive than what theyhave. Everybody has to go according to their regional prevalence of diseaseand decide what's appropriate for each individual's risk."

AAHA's version

AAHA distinguishes itself from previous guidelines by dividing specificcanine vaccines into triennial and annual categories. The report also includesa "Not Recommended" category. However, the AAHA task force emphasizesthere is no "blanket" or "generic" statement to encompassuse of all vaccine products. To reinforce its position, the report notes,"In the end, each veterinarian must do what he or she determines tobe in the best interest of the patient."

Current research suggests that no vaccine is always safe, no vaccineis always protective, and no vaccine is always indicated. Given that, AAHAguidelines are intended to serve as points of reference for veterinarianswho question use of specific vaccines.

Dr. Kathleen Hutton, a relief veterinarian based in Cincinnati, Ohio,says that while helpful, the guidelines don't go far enough.

"I would like to see better guidelines. This division into coreand non-core is wishy-washy," she says.

Hutton says she'd like substantive titer data to correspond with therecommendations.

"I'd like to see, here are the titers that are protective. Thisis when you should revaccinate. I'd like to see more use of titers in determiningvaccination schedules," Hutton says.

Echoing Hutton is Dr. Bill Utroska of Southhaven, Miss.

"Core and non-core are a good step in the right direction on whatand when we vaccinate. Everybody doesn't need everything every year. Butuntil we have more practical ways, such as checking titers, I'm not surethat absolutely going away from annual is a good thing in every case."

In the trenches

Few practitioners cited instances where they would use vaccines thatAAHA ruled against. However, practitioners started to split on which vaccinesto use annually and which to use less. Some opted against the lepto vaccine,due to adverse reactions, others give it based on risk assessment. Somewill only use bordetella for boarding situations or show dogs; most saythey only give Lyme as their region dictates.

Many veterinarians say their vaccination plans were already modifiedbased in part on prior reports from the AVMA and AAFP. More importantly,veterinarians indicate they plan to adjust their vaccination schedules notaccording to association guidance, but according to the individual animal.

"Although clinics and areas may have recommended protocols (fromAAHA or AVMA) it has to be tailored to each animal in each situation,"says Dr. Elizabeth Coney, who practices in Georgetown, Ky.

She says she always considers an animal's risk exposure prior to administeringcertain vaccines. "Some farm animals out and about get leptospirosisvaccine because they're out in fields with cattle and creeks. It's a caseby case basis," she says.

Duration of immunity

Embedded in the vaccination discussion is the question of duration ofimmunity. Although Epstein welcomes the new guidelines, he still wonderswhy AAHA picked three years as the recommended time between select vaccines.

"The three-year recommendation is still about as arbitrary as two-yearor four-year. There's no medical justification for three years. Why didthey do it then? It's a palatable place to start. It makes it difficultfor those veterinarians who continue to give vaccines every year to defendthat position," he says.

One criticism of the report is that it lacks sufficient data to proveduration of immunity does last longer than a year. Until recently no bodyof evidence existed to support such a theory.

"I would like to see the research advance to give us more data thatcontinues to support the duration of immunity studies that already suggestthe fact that these vaccines last longer than even three years," hesays.

Epstein already speculated that duration was much longer than was reported."When it comes to vaccinating, we can draw from our intuition thatprobably once an animal reaches adulthood (and has been vaccinated as apuppy) after that you can surmise that the pet's immune system will probablyhold it for the rest of its life," he says.

"Some vets are still waiting for some kind of proof positive,"he adds.

No annuals, no visit

Aside from questions of adequate research, of utmost concern to veterinariansis not the reduced frequency of vaccinations, but the reduced frequencyof client visits.

To Rucker, it's not the loss of vaccination income that worries her."I worry about the loss of opportunity to examine that animal to findheart murmurs, enlarged kidney, bladder infection before the problem gotso advanced."

Having conditioned his clientele that pets need annual vaccines, Dr.Andrew Murphie says he modified his vaccine program to keep clients comingback.

He's staggered the vaccination schedule: the first year, the dog receivesa distemper vaccine, the second year, parvo; third year, rabies. Clientsare charged a fixed office exam fee, and the vaccine is free.

"That way we're not hitting them with all the antigens each year,stressing their immune systems and they're getting something for their dollar,"adds Murphie.

At Coney's practice she believes it's essential to inform the clientthat while vaccination is essential to the wellness of an animal, it's onlyone minor part.

"I stress the importance of annual wellness exams to catch otherproblems. They can spend those dollars on bloodwork, blood pressure testing,EKG testing, dental prophylaxis. It frees up more of their pet care dollarsto provide better overall care for the pet," Coney adds.

Client beefs?

Few veterinarians cited client concerns, but of those who did, theirworries were commonly associated with questions of whether vaccines causedautoimmune disease and cancer.

Jarboe says she's fortunate: "Most of our clients are a well educatedbunch, they understand that immunology is a work in progress. I think theyappreciate that we are providing them with the most recent information availableand realize things could change next year."