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.