Title: Changes in canine vaccination protocols
1Changes in canine vaccination protocols
- John Walters
- Manager SE-Asia
2Purpose
- 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?
3Issues
- 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?
4Vaccine 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
5Growing Concern
- Are veterinarians vaccinating
- against too many diseases in
- too many patients?
6Antigen overload in animals?
7Antigen 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
8Antigen 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
9No 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
10No 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
11Conclusions
- 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
12Talking about herd immunity
13Is annual re-vaccination optimal?
14Scott 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)
15Scott 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.
16Lappin 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)
17Lappin 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)
18Lappin - 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
19Lappin - Conclusions
- SQ VACCINES
- (ECLIPSE Schering Plough
- FEL-O-VAX Fort Dodge)
- AGAINST FCV, FHV AND FPV WERE EFFECTIVE UP TO 36
MONTHS POST ADMINISTRATION
20Is 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)
21Is 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
22Is 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.
23Advancing 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
24Justification for longer intervals
- Concern that vaccine risk is excessive
- Suggestion that fewer vaccinations should reduce
risks
25Risk Assessment
- What is meant by risk?
- Risk of infection
- Risk of adverse reactions after vaccine
administration
26Vaccine Use Has Risks
- Vaccines are not innocuous substances
- Common Transient
- fever, lethargy
- Uncommon Transient
- allergy
- Uncommon Fatal
- anaphylaxis, reversion (ISS cats)
27Duval and Giger Study9
- Duval D, Giger U.
- Vaccine-Associated Immune-Mediated Haemolytic
Anaemia in the Dog. - J Vet Inter Med 1996 10290-295.
28Duval 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
29Duval and Giger
- Significant difference (p
- number of dogs seen within one month
- and controls
- This temporal relationship strongly supports
vaccine can trigger IMHA
30Duval 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.
31Carr 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.
32Carr - 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.
33Confusion?
- 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
34Expectations 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
35Decide 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
36Inform 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
37Inform and Educate Your Clients
- State your policy
- Brochures and handouts
- Newsletters
- Informed and trained staff to answer questions
- (Consent forms for immunisations)
- Be Proactive
38Patient 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?
39The way forward
40Fort 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
41A new vaccine with longer DOI claims
42Technical 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
43Technical 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
44Canine Distemper
45Technical 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
46Technical Review
Clinical scores
Days post challenge
47Canine Hepatitis
48Technical 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
49Technical Review
Clinical scores
Days post challenge
50Canine Parvovirus
51Technical 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
52Technical Review
Clinical scores
Days post challenge
53Study 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.
54Recommended 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.
55Duramune 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
56Remember
-
- Vaccination is the most effective and
- cost-efficient component of a
- comprehensive preventive health care
- program that controls infectious diseases
- in pet populations.
57Summary
- 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
58Summary
- 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
59In 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
60References
- 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. -
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