Tag Archives For: vaccines

30 Apr, 2013

What vaccines to give? – Part 1

/ posted in: Work

If I don’t recommend vaccinating for everything possible in dogs, what do I think you should vaccinate for?  Here’s a look at the common vaccines.

Distemper combination

This goes by lots of names – DAPP, DHLPP, 5-way, etc.

  • D = Distemper – Distemper causes respiratory and neurologic signs in dogs of all ages.  It is pretty rare in the pet population now thanks to vaccination.  It is still seen in raccoons, foxes, and other wildlife.  Cat distemper is an unrelated virus.  I have never seen a confirmed case in practice.  I’ve probably seen dogs with it but missed it because it is not really on our radar much anymore in the U.S.  It is still very common in areas where vaccination isn’t practiced widely.  (Side note – This is not “distemperment” and it is not related to fixing aggression in dogs.)
  • A/H = Adenovirus or Hepatitis – This is the same virus regardless of what it is called.  Adenovirus causes infectious hepatitis.  This disease is mild and dogs usually recover.  Again, I’ve never seen a confirmed case because we don’t look for it.  The vaccine is usually actually a variant of adenovirus that causes respiratory disease (A2) and causes cross immunity.  There have been suggestions that one vaccine is enough to cause lifetime immunity but all common distemper vaccines include this.
  • P = Parvo – Parvo is a disease that started in the 1970s.  It causes severe vomiting and diarrhea.  The virus destroys the lining of the intestine so no nutrients can be absorbed.  This is a disease that we see all the time.
  • P = Parainfluenza – If there is a second P in the vaccine it is parainfluenza.  This is a respiratory disease that can be one of the components of kennel cough.
  • L = Leptospirosis – This is the most controversial vaccine in the dog world.  It is a bacteria that people, dogs, and wildlife can get and spread in urine.  It causes kidney disease.  It is considered to be the most reactive vaccine.

So, lepto.  Depending on who you read you’d hear that the vaccine is a killer or that the disease is a killer.  No one can prove either one definitively.  I went to a lecture on this recently.  The speaker asked us to raise our hands if we had ever seen a reaction from a lepto vaccine.  Every hand in the room shot up.  Then he asked if we could absolutely prove that the reaction was from the lepto component of the vaccine.  Most dogs who have had reaction have had other vaccines in combination.  Some hands stayed up because they had reactions from lepto given alone.  He asked how many of them had had a reaction on the first time they had given that dog lepto.  Hands were up.  He said that proved it wasn’t an allergic reaction to lepto because you have to have been exposed previously to something in order to have an allergic reaction to it.  He used that point to blow off concerns about safety of the vaccine.  That didn’t go over well based on the grumblings in the room.

All of my very, very severe vaccine reactions have been in small dogs who got the lepto vaccine in combination with DAPP.  Two of the three were getting it for the first time.  Can I prove it was the lepto?  Nope, but something was going on when that particular combination of vaccines was given.

No one can even say for sure how widespread leptospirosis is.  The studies haven’t been done.  There is one large study looking at cases set to a lab in Ohio which is convenient since that’s where I am.  Lots of samples were tested.  Only a few came up positive. Personally, I’ve never seen a confirmed case of lepto.  I’ve looked.  I’ve had a few dogs with textbook signs who all came back negative on titer testing.

The way I see it is that I’ve seen hundreds of vaccine reactions ranging from mild signs up to death after the lepto vaccine and no confirmed cases of the disease.  I don’t want to give it to anyone.

Ask 10 vets about this and you’ll get 10 different answers.  We can’t even get a consensus between the three vets in my practice.  One vet gives it to everyone because it is being found more and more in wildlife in our area.  I want to see a notarized picture of the dog snuggling with a raccoon before I give it to anyone under 20 lbs.  We can’t get an answer from the manufacturer.  We called last week to see what the reported rate of reaction was and all they would say is that they couldn’t give us an accurate number because not all reactions are reported.  We told them to tell us what was reported and we’d just assume that the real number was a lot higher but they wouldn’t tell us.

What we do now is a lifestyle assessment.  We ask how much wildlife exposure the dog has.  I find that the answers are skewed based on the biases of the person asking the question.  Some of my staff is totally anti-lepto.  They start with the assumption that the dog in front of them will not get it and ask the questions to see if the dog really does need it.  Some of the staff is not opposed to it and they ask questions starting with the assumption that the dog will get it unless the owners want to opt out.  We are working on a more unified approach but it is hard because there is no real data to base anything on.

What do I do for my dog?  She has had a few DAPP vaccines since I got her at age 5.  She doesn’t get lepto.  I’m going to be moving her to a 3 year DAP vaccine from now on.  I may also start titer testing her to see what (if anything) she really needs.

What is my ideal vaccination schedule?  I think puppy vaccines are vitally important.  I see a lot of parvo.  I see parvo in the dead of winter when you’d think any contaminated fecal material would be buried under the snow so dogs wouldn’t be exposed.  I recommend that boosters start at 8 weeks of age and be given every 4 weeks until 16 weeks.  After that I’d give a DAPP booster at one year and then transition to a 3 year DAP vaccine at age 2.  Ideally, I’d give distemper only at this point but that isn’t an option in the current vaccines I have available.  Parvo is mainly a puppy disease.  I’ve never seen an adult dog who has been vaccinated get it.  (Knock on all kinds of wood.) I’ve seen a lot of adult unvaccinated dogs who have a puppy with parvo in the house with them who never get sick.  The only adult dogs I’ve seen come down with parvo were unvaccinated and part of a severe outbreak on a farm where all 10 dogs died.  They had several generations of unvaccinated dogs and I don’t think anyone had any immunity at all.

Stay tuned for more ramblings on rabies, bordatella, and other vaccines.

 

30 Apr, 2013

Vaccines

/ posted in: Work

More thoughts after reading Pukka’s Promise.  The author recommends limited vaccinations.  Vaccines are something that I spend a lot of time thinking about.  First, some background.

For the first 14 years I was in practice I was mainly a relief vet.  That means I went into a lot of practices when vets need time off.  Vaccine protocols vary widely.  There were clinics I wouldn’t go back to because I could not justify giving the number of vaccines that they required.  When we moved last year I started working for a wellness clinic.  One of my concerns was what their vaccine protocols were.  I did not want to be in a position where I was just giving dogs all the vaccines in the fridge.  I have way too many reservations about vaccines for that.  The vaccine policy at this clinic is one of the most sane that I’ve seen in practice.  For dogs it comes down to this:

  1. Dogs under 20 lbs never receive more than one injectable vaccine at a visit.
  2. If your dog is sick, you don’t get vaccines no matter how much you want them.
  3. The staff evaluates each dog’s lifestyle to see what vaccines to recommend.

Seems simple and logical right?  Oh, the wailing and weeping and gnashing of teeth that happens sometimes.  I spend much more time in my day telling people I won’t vaccinate their dog than I do recommending more vaccines.  In fact, for dogs, I never recommend more vaccines.

The under 20 lb rule comes from studies that show that small dogs are more likely to have vaccine reactions than big dogs.  If a small dog is due for multiple vaccines they can come back in 2 weeks for the other vaccine and they won’t be charged an additional office call.  If the dog is sick with something I expect to clear up in 2 weeks (like an ear infection), they can take advantage of that too.  Because of that people can’t claim that we are just trying to take more money from them.

I’m sorry if you didn’t plan ahead and are leaving for vacation tomorrow and your Chihuahua needs a bunch of vaccines to be able to go to the kennel.  I don’t care if he’s had them done all at once before and it has never been a problem.  There are clinics that will do that for you.  We won’t.

People always want vaccines “as long as we’re here.” No.  Vaccines are not benign things that can be given whenever.  If your dog has been vomiting for 3 days I’m not vaccinating it.  Severe allergies and skin infection?  No vaccines.  My all time favorite was the dog who went outside at 4 AM and came back with both eyes out of his head.  They were dangling from the nerve.  The owner popped them back in.  I saw him at noon.  Noon.  Eight hours later.  The eyes were pointing opposite directions and one was obviously blind.  I was grabbing eye specialist referral sheets to try to save his vision and the owner kept saying he just brought him in for a rabies shot.  I made a new rule on the spot that if your eyes have been out of your head at any time in the last 24 hrs, you aren’t getting vaccines.

It surprises me that people think of vaccines as harmless. I don’t expect people to be up to date on veterinary literature but the idea that vaccines can have side effects is in the news a lot.  People often act like this is a new idea to them.  As a profession we’ve done a good job convincing people to vaccinate their animals and it has helped in a lot of ways but I think we’ve gone too far.

Everyone who gets a vaccine at our clinic goes home with a handout listing possible vaccine reactions.  These range from mild things like being tired or being sore at the vaccine site to severe reactions like hives, vomiting, collapse, and death.  What do we actually see?  I ask every time before I give a vaccine how they felt after their last one.  Most owners don’t notice any problems.  Some say they are tired or sore.  Sometimes there are reports of vomiting once but it can be hard to say if that is the vaccine or the car ride and excitement.  If they have hives or any other severe reaction we generally know about it when it is happening.

In the past year I’ve seen 3 anaphylactic reactions to vaccines.  I’ve never seen any before.  They are scary.  The dogs start vomiting over and over.  They are very weak.  They are pale.  Immediate treatment is needed.

What do we do if dogs have had a reaction?  If it is mild and their lifestyle is such that they should continue to have vaccines, we premedicate them with benedryl and maybe steroids.  If they have any more reactions with the premeds they are done.  We don’t vaccinate them anymore.  Obviously, one severe reaction means that they don’t get any more vaccines.

I say “obviously” but it isn’t.  I’ve had people fight me on this.  One of the anaphylactic dog’s owners wanted to give him another vaccine.  I’ve had dogs who have broken out in hives despite premedication with owners almost in tears because I said he shouldn’t be vaccinated again.

There are other dogs that I think shouldn’t have vaccines.

  1. Old dogs. Most of the diseases we vaccinate for are disease of young dogs.  I would rather spend a person’s money on bloodwork for elderly dogs than vaccines.
  2. Cancer patients.  They already have enough problems without adding more immune system stress through vaccination.  I had one owner with a dog who had been through chemo and was now in remission from lymphoma get furious with me for telling him that I thought the dog should not be vaccinated.   He said that I was the only vet saying that to him so obviously I didn’t know what I was talking about.

I think people are concerned that not vaccinating their dogs is a death sentence because they are going to pick up all the horrible infectious diseases that are out there the day after the vaccine officially expires.   The next post will be about what we actually vaccinate for and who should get the vaccines.

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