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Changes in canine vaccination protocols

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Title: Changes in canine vaccination protocols


1
Changes in canine vaccination protocols
  • John Walters
  • Manager SE-Asia

2
Purpose
  • Help understand the controversial vaccine issues
    we are facing today
  • Review published data
  • The science behind new vaccines
  • Trial data
  • Claims
  • Discuss various vaccination protocols
  • Is there a right or wrong protocol?

3
Issues
  • Which vaccinations should be given to a specific
    individual and how often should they be given?
  • What is the true duration of immunity of the
    vaccines with which we vaccinate?
  • Is more harm than good being done in the course
    of routine vaccine administration?
  • Are these issues being discussed with owners?

4
Vaccine Use
  • Historically Accepted
  • Mass vaccinations
  • Set interval re-vaccination for life
  • We have objective data regarding
  • Early use
  • Repeat initial boosters
  • Anamnestic response
  • Maternal blockade

5
Growing Concern
  • Are veterinarians vaccinating
  • against too many diseases in
  • too many patients?

6
Antigen overload in animals?
7
Antigen overload in children
  • Dr Paul Offit
  • Current studies do not support the hypothesis
    that polyvalent vaccines overwhelm the immune
    system of infants1
  • Cohn Langman
  • Each person can respond to about 100,000
    different antigens at the same time2
  • 1 Offit et al. Pediatrics. 2002109124-129
  • 2 Cohn Langman. Immunol. Rev. 19901151-113

8
Antigen overload in dogs
  • "There is no scientific evidence that either
    antigen overload or vaccine interference occurs
    with the currently available canine or feline
    vaccines."Dr. Ron Schultz - January 1997

9
No post-vacc immunosuppression
  • Immune modulation following immunization with
    polyvalent vaccines in dogs3Strasser A et al.
    Vet Immunology and Immunopathology 94 (2003)
    113-121.
  • Significant post-vaccinal decrease
  • T-cell mitogenic response to PHA
    (Phytohaemagglutin kind of mitogen)
  • Neutrophil function
  • Neopterin serum concentrations (a
    pyrazinopyrinidine compound, useful in assessing
    activation of cellular immunity)
  • Significant post-vaccinal increase
  • Plasma IgG
  • Haemolytic complement activity

10
No post-vacc immunosuppression
  • Immune modulation following immunization with
    polyvalent vaccines in dogs
  • Strasser A et al. Vet Immunology and
    Immunopathology 94 (2003) 113-121.
  • Our major findings .. suggest a
  • transient shift
  • in the balance between
  • cell-mediated and humoral immunity
  • rather than immunosuppression

11
Conclusions
  • Vaccination is the most effective and
    cost-efficient component of a comprehensive
    preventive health care program that controls
    infectious diseases in populations.
  • Current preventative medicine practices are
    highly effective in controlling many infectious
    diseases
  • Anti-vaccine movements can have deleterious
    effects on herd immunity and individual health

12
Talking about herd immunity
13
Is annual re-vaccination optimal?
14
Scott Challenge Study 4
  • Continuation of the original study
  • Published in AJVR May 1999
  • 17 x SPF cats
  • 9 vaccinates
  • 8 controls
  • Challenged 7.5 years after vaccination
  • (Fel-O-Vax 3)

15
Scott Results Conclusions
  • Reduction in clinical disease
  • FHV 52
  • FCV 63
  • FPV 100? (Control cats did not get sick)
  • Conclusion
  • Duration of immunity after vaccination with an
    inactivated, adjuvanted vaccine was 7 years.
    Protection against FPV was better than for FHV
    and FCV.

16
Lappin Challenge Study 5
  • FCV 18 controls / 38 vaccinates
  • (14 IN, 24 SQ)
  • FHP 14 controls / 26 vaccinates
  • (14 IN, 12 SQ)
  • FPV 14 controls/ 25 vaccinates
  • (13 IN, 12 SQ)

17
Lappin Challenge model
  • IN vaccinates were challenged at 9, 10 11
    months post vaccination for FPV, FHV FCV
    respectively. (10 controls)
  • 12 SQ vaccinates were challenged at 30 31
    months post vaccination with FPV and FHV resp.
    (4 controls)
  • 24 SQ vaccinates (18 Fel-O-Vax 3) were
    challenged 24 - 36 months post vaccination with
    FCV (8 controls)

18
Lappin - Results
  • FPV challenge
  • all 14 control cats became infected, none of the
    vaccinated developed infection
  • FHV challenge (PF Preventable Fraction)
  • all 14 control cats became infected, PF in IN
    group was 63, SQ group was 67 (USDA approved
    vaccine criteria)
  • FCV challenge
  • all 14 control cats became infected, PF in IN
    group was 92, SQ group was 94

19
Lappin - Conclusions
  • SQ VACCINES
  • (ECLIPSE Schering Plough
  • FEL-O-VAX Fort Dodge)
  • AGAINST FCV, FHV AND FPV WERE EFFECTIVE UP TO 36
    MONTHS POST ADMINISTRATION

20
Is Immunity Greater than 1 Year?6
  • Duration of serologic response to five viral
    antigens in dogs. Duration of serologic response
    to three viral antigens in cats.
  • Mouzin DE, Lorenzen MJ, Haworth JD, King VL.
    JAVMA 200422455-66.
  • Dogs
  • 322 Client owned dogs not vaccinated within the
    prior 12 months out to over 48 months
  • In most dogs, vaccination induce a response that
    lasted up to 48 months for five viruses (CDV,
    CPV, CAV1, CAV2, CPIV)
  • Cats
  • 272 client owned cats not vaccinated within the
    prior 12 month out to over 48 months.
  • In most cats, vaccination induce a response that
    lasted up to 48 months for three viruses (FHV,
    FPV, FCV)

21
Is Immunity Greater than 1 Year?
  • Duration of serologic response to five viral
    antigens in dogs. Duration of serologic response
    to three viral antigens in cats. Mouzin DE,
    Lorenzen MJ, Haworth JD, King VL. JAVMA
    200422455-66.
  • No challenge data!
  • The gold standard in determining duration of
    immunity
  • Expensive
  • Conducted in experimental locations
  • Enhanced immunity or booster effect of natural
    disease expose unknown

22
Is Immunity Greater than 1 Year?
  • Duration of serologic response to five viral
    antigens in dogs.
  • Duration of serologic response to three viral
    antigens in cats.
  • Mouzin DE, Lorenzen MJ, Haworth JD, King VL.
    JAVMA 200422455-66.
  • Quotes
  • challenge of immunity studies conducted over
    multiyear periods are expensive and impractical
    to the extent that vaccine manufacturers do not
    ordinarily consider them.
  • Historic annual revaccination have resulted in
    excellent disease control.
  • Effect of extended-interval vaccination on
    canine and feline population immunity is
    unknown.

23
Advancing Academic Opinion
  • Population immunity will never be 100
  • Duration of immunity 1YR
  • CDV, CAV1, CPV2, RV
  • FPV, FHV1, FCV
  • Less frequent vaccine intervals should not
    significantly impact population immunity

24
Justification for longer intervals
  • Concern that vaccine risk is excessive
  • Suggestion that fewer vaccinations should reduce
    risks

25
Risk Assessment
  • What is meant by risk?
  • Risk of infection
  • Risk of adverse reactions after vaccine
    administration

26
Vaccine Use Has Risks
  • Vaccines are not innocuous substances
  • Common Transient
  • fever, lethargy
  • Uncommon Transient
  • allergy
  • Uncommon Fatal
  • anaphylaxis, reversion (ISS cats)

27
Duval and Giger Study9
  • Duval D, Giger U.
  • Vaccine-Associated Immune-Mediated Haemolytic
    Anaemia in the Dog.
  • J Vet Inter Med 1996 10290-295.

28
Duval and Giger
  • Retrospective study (N58)
  • 26 (N15) dogs Dx idiopathic IMHA
  • vaccinated within one month
  • 66 (N31) seen within one year
  • 8 (N-13) seen 13-55 months PV

29
Duval and Giger
  • Significant difference (p
  • number of dogs seen within one month
  • and controls
  • This temporal relationship strongly supports
    vaccine can trigger IMHA

30
Duval and Giger - Discussion
  • Effective and safe vaccination is an
  • important part of preventive health care
  • for dogs and people, since the risks of
  • contracting infectious diseases are much
  • higher than those of vaccine-associated
  • problems, including IMHA.

31
Carr Study10
  • Carr A., Panciera D., Kidd L.
  • Prognostic Factors for Mortality and
    Thromboembolism in Canine Immune-Mediated
    Hemolytic Anemia A Retrospective Study of 72
    Dogs.
  • J Vet Inter Med 2002 16504-509.

32
Carr - Discussion
  • 52 dogs with vaccine history
  • 10 of dogs were vaccinated within 1 month
  • An association between vaccination and IMHA was
    not identified in our study.
  • Given our data and that of previous studies, the
    association between vaccination and IMHA remains
    unproven.
  • Poodles, Cocker Spaniels, Irish Setters, English
    Springer Spaniels and Collies have been
    identified to be at higher risk for IMHA.

33
Confusion?
  • What is clear is that there is controversy
  • But you have to make health care choices today
  • Fort Dodge strongly recommends veterinarians to
    clearly communicate to clients

34
Expectations of vaccine effectiveness
  • .Prevention of infection
  • Sterile immunity
  • One vaccine can make this claim (which one??)
  • to prevent signs of disease
  • 80 of vaccinates should be free of infection or
    disease in contrast to a reasonable amount of
    disease in the non-vaccinated controls. (9
    CFR(code of federal regulations) Part 113)
  • to aid in the prevention of disease
  • Vaccinates are less sick than controls

35
Decide Practices Vaccine Policy
  • Educating yourself the best you can
  • Have a policy
  • Set intervals
  • Risk based intervals
  • Select vaccines that best fulfill your policy
  • Be confident in your decision
  • Defend your decision with information
  • The worst policy is no policy

36
Inform and Educate Your Staff
  • Staff is usually the first point of contact
  • Staff understands and believes in policy
  • Uniform message
  • Eliminate misunderstanding and miscommunication
  • Education of client has begun before contact with
    veterinarian
  • Client knows staff is up to date on issues

37
Inform and Educate Your Clients
  • State your policy
  • Brochures and handouts
  • Newsletters
  • Informed and trained staff to answer questions
  • (Consent forms for immunisations)
  • Be Proactive

38
Patient Assessment
  • Ask questions carefully and look for real
    answers
  • Evaluate each individual pet
  • Who is the pet?
  • Who is the owner?
  • What is their relationship?
  • Lifestyles
  • Nutrition
  • Environment
  • Is pet indoor or outdoor?

39
The way forward
40
Fort Dodge
  • Are leading international research in this area
  • Launched a vaccine in the USA that can be used in
    vaccine protocols with intervals from 1-3 years
  • Three year interval was based on challenge (gold
    standard)
  • Information regarding trial was published in peer
    reviewed journal (JAVMA)
  • New vaccine with new claims now registered in
  • USA
  • Australia/ New Zealand
  • Europe

41
A new vaccine with longer DOI claims
  • Duramune AdultTM

42
Technical Review
  • Studies initiated more than 4 years ago
  • Diseases studied
  • Parvo
  • Distemper
  • Adenovirus
  • Strictly controlled laboratory conditions
  • Eliminates enhanced immune response from
    non-vaccine sources

43
Technical review
  • Materials and Methods
  • 6 week old pups received 2 doses 3 weeks apart
  • Housed in isolation facilities
  • Vaccinates and controls were challenged 3 years
    after 2nd vaccination
  • 14 day (CPV) or 3 week (CDV and CAV-2)
    observation period post challenge

44
Canine Distemper
45
Technical Review
  • Results and Discussion
  • Clinical scores assigned based on severity of
    clinical signs
  • Vaccinates
  • No apparent signs of distemper
  • All appeared healthy and active
  • Some mild and transient signs
  • Controls
  • Clinical signs observed included mucopurulent
    occular discharge, severe conjunctivitis, and
    watery/bloody diarrhoea

46
Technical Review
Clinical scores
Days post challenge
47
Canine Hepatitis
48
Technical Review
  • Results and Discussion
  • Clinical scores assigned based on severity of
    clinical signs
  • Vaccinates
  • Some mild and transient signs
  • In general they were healthy and active
  • Controls
  • Severe conjunctivitis
  • Ocular discharge
  • Coughing

49
Technical Review
Clinical scores
Days post challenge
50
Canine Parvovirus
51
Technical Review
  • Results and Discussion
  • Clinical scores assigned based on severity of
    clinical signs
  • Vaccinates
  • Some dogs showed mild and transient signs
  • In general all vaccinates were happy and healthy
  • Controls
  • All sick and weak with intermediate to severe
    clinical signs
  • Bloody/watery stools, lethargy and depression
  • 1 control dog died

52
Technical Review
Clinical scores
Days post challenge
53
Study conclusion
  • The challenge trials conducted according to
    international research standards13 resulted in
    conclusive evidence that Duramune Adult vaccine
    is efficacious in protecting puppies 6 weeks of
    age and older against virulent CDV, ICHV and CPV
    infection for three years following second
    vaccination.

54
Recommended program
  • Duramune Adult C3 and C4 have been
    demonstrated to provide 3 years protection
    against disease caused by canine distemper virus,
    canine adenovirus type 1, canine adenovirus type
    2 and canine parvovirus.
  • These vaccines may therefore be included in
    programs of revaccination intervals of 3 years
    following the primary vaccination program.
  • These vaccines may also be used for shorter
    revaccination intervals if desired. For instance,
    a common international practice is for dogs to
    receive their first revaccination at 12 months
    after the primary puppy vaccination and at 3
    yearly intervals thereafter.

55
Duramune AdultTM
  • Providing you and your patients with the latest
    technology
  • 3 years protection against canine distemper,
    hepatitis and parvovirus
  • Protection based on challenge data, not just
    serology
  • More flexibility with vaccination protocols
  • Strongly supported by international research

56
Remember
  • Vaccination is the most effective and
  • cost-efficient component of a
  • comprehensive preventive health care
  • program that controls infectious diseases
  • in pet populations.

57
Summary
  • Vaccines are only part of a preventive program
  • Annual revaccination can not be optimal for all
    diseases for all patients
  • Optimal revaccination intervals are not yet known
  • Once-A-Year health checks are recommended for all
    dogs

58
Summary
  • Each veterinarian must establish a policy for
    his/her own practice
  • Select vaccines that best fulfill your policy
  • Educate your staff
  • Assess each animal individually
  • Provide clients with adequate information to make
    an informed decision on health care
  • Be confident you have offered the best medical
    advice on preventive healthcare

59
In Closing
  • Vaccination is a medical intervention no medical
    intervention, even the simplest, is free of
    complications at all times.
  • The issue is not which position is right or which
    position is wrong, but rather, which one is most
    defensible.
  • The answer to these questions is ever evolving

60
References
  • 1. Offit P et al. Addressing Parents concerns
    Do multiple vaccines overwhem or weaken the
    infants immune system? Pediatrics.
    2002109124-129.
  • 2. Cohn M and Langman RE. The protecton the
    evolutionarily selected unit of humoral immunity.
    Immunol. Rev. 1990 1151-113
  • 3. Strasser A et al. Immune modulation following
    immunisation with polyvalent vaccines in dogs.
    Veterinary Immunology and Immunopathology. 2003
    9413-121.
  • 4. Scott FW, Cordell M, Geissinger BS. Long-term
    immunity in cats vaccinated with an inactivated
    trivalent vaccine. American Journal of Veterinary
    Research 199960(5)652-658
  • 5. Lappin MR, Andrews J, Simpson D, Jensen WA.
    Use of serologic tests to predict resistance to
    feline herpes virus 1, feline calicivirus, and
    feline parvovirus infection in cats. Journal of
    the American Veterinary Medical Association
    2002220(1)38-42.
  • 6. Mouzin DE, Lorenzen MJ, Haworth JD, King VL.
    Duration of serologic response to five viral
    antigens in dogs. J Am Vet Med Assoc
    2004224(1)55-60.
  • 7. Moore GE, Glickman LT. A perspective on
    vaccine guidelines and titer tests for dogs. J Am
    Vet Med Assoc 2004224(2)200-203.
  • 8. Principals of vaccination-COBTA(Council on
    Biologic and Therapeutic Agents). J Am Vet Med
    Assoc 2001219(5)575-576.
  • 9. Duval D, Giger U. Vaccine-associated
    immune-mediated hemolytic anemia in the dog. J
    Vet Int Med 199610(5)290-295.
  • 10. Carr AP, Panciera DL, Kidd L. Prognostic
    Factors for Mortality and Thromboembolism in
    Canine Immune-Mediated Hemolytic Anemia A
    Retrospective Study of 72 Dogs. J Vet Int Med
    200216504-509.
  • 11.  Australian Veterinary Association. Policies.
    3.7 Guidelines for Responsible Use of Veterinary
    Immunobiologicals in Cats and Dogs.
    http//www.ava.com.au/policy.php?policyid63
    retrieved 26 April 2005.
  • 12. New Zealand Veterinary Association. Vaccine
    use in companion animals in New Zealand.
    Companion Animal Society of the NZVA Public
    Policy Statement. http//www.vets.org.nz/Vetzone/M
    anual/SectB/Policies/B1_1_6202003.pdf retrieved
    27 April 2005.
  • 13. Canine Distemper Vaccine (Live),
    Freeze-Dried. European Pharmacopoeia 4TH ED
    20042244.

61
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