Vaccinations...........Fact vs Fiction

Vaccination protocols for small animal medicine are a changing and controversial practice. This situation is not unlike that found in human medical. Even the recent reintroduction of small pox vaccine for terrorist protection, has yea and nay individuals expounding. From Autism to Fibromyelagia, the gamet of alleged vaccine induced diseases have their accusers. So too, many animal disease phenomena are thought by some to be caused by immunization.

The basis to decide which, if any vaccines, can best serve your pet comes by using science, and logic. There is no doubt that without vaccines, animal medicine and mankind would be less served. This is especially true in veterinary medicine when one thinks of food animal and equine medicine. Many devastating diseases are avoided in the agriculture and horse industries with the use of vaccine programs. These diseases could easily wipe out significant food protein sources. From Budweiser beauties to the Triple Crown and Mid-Evil Times, the horses of this world would be at serious risk without immunizations. Our household pets no longer have to suffer from rabies, distemper, and enteric forms of highly contagious fatal diseases. This can best be demonstrated by reading the world literature prior to the introduction of these biological preventatives. Some thought before not using available vaccines in pets should be given.

It's well documented in science publication, that the vast majority of immunizations approved for use in humans and animals work well. Double blind challenge studies to get the vaccines approved. as well as subsequent post vaccinate epidemiological studies have proven their effectiveness. It's also well documented that all vaccines have the potential to produce adverse reactions in a few individuals, despite safety testing. Common sense tells us their justified use is a matter of risk factors, both in the disease exposure, and vaccine side effects , and the consequences of enduring the disease. This is true of every medical advancement from birth control pills to penicillin, from organ transplant to cosmetic surgery, and from x-rays to seat belts. We have to constantly weigh the risk-benefit balances for each application.
Not all vaccines are indicated in every patient. If we had a working AIDS vaccine, you wouldn't need it if you lived on an isolated island with a disease free human population.

In addition to weighing the risk factors in each immunization decision, pet owners have to demand documentation to support the statements made by other people who recommend the use or disuse of vaccines. What are their academic credentials? Where are the epidemiological facts or double blind studies to support their statements? Most statements that get printed, broadcast, or internet posted in this country about vaccines are not science speaking. Roomers and innuendo are a large part of our sensationalistic media. It's unlikely that we would ever board a commercial jet airliner, if the science used to test those crafts' safety was equivalent to that found in most of the recent vaccine statements that are heralded. Put the burden of proof on the recommender! Don't take every phrase they utter as gospel. There are no good epidemiological studies to show that pet medicine vaccines are creating needless or excessive diseases or suffering. The facts are overwhelming that the opposite thus far has occurred. Much more suffering and loss of animal life would occur if vaccination programs were halted.

In small animal pet medicine we have enjoyed the benefits of immunization to allow most pets to reach a ripe age free of the diseases the vaccines were designed to protect from. Some recent statements made in the veterinary literature, and especially the internet have concluded that we are "over vaccinating" our pets. This is concluded because of two basic impressions: one that significant diseases are the direct result of a recent immunization, or two that most vaccinated pets are protected for much longer periods of time than present vaccination protocols give them credit for.

Now the diseases implicated have been documented historically for longer than the existence of the vaccines, and these same diseases also occur in unvaccinated populations as well. So science and common sense say how much additional disease, if any, is caused by vaccines, and are there good vaccine studies to show how long vaccines will protect? These are the key questions that science needs to answer still.

To date if you look for epidemiological studies to give us some idea of vaccine induced disease, they are sparse. The best know veterinary work is the fact that a correlation to fibro sarcoma cancer at the injection site can occur more often in cats, not dogs or ferrets; than non immunized cats. The rate of incidence is extremely low, but does exist. Reported numbers of the other suspected diseases that are seen are even less, when compared to the number of animals receiving vaccines. A point to remember here is that although polio immunization is required by law for our children, a few children acquire the disease every year from that same vaccine. Still the benefits by logic and science have out weighed the risks and we vaccinate our children. In addition most of the reported adverse reactions to pet immunizations are mild and temporary; these are not numerous new diseases that affect the patients for the rest of their lives.

The only vaccines that good long term challenge studies are required in, before final commercial approval by our government are for rabies virus. This is in part because challenge studies in general are very expensive to do, and rabies is a zoonotic disease with heavy human implication (it's lethal in man). Rabies research gets human funding. So we don't know how long most other animal disease vaccines will protect. We do know that the duration of immunity is different for every patient even given the same vaccine. The assumptions have been that blood titers for antibodies produced in the body's blood stream by vaccine exposures correlate to protection levels. Unfortunately, titers are not equivalent to challenge studies or the real disease challenge if you will, and could be worthless for protection, and yet be at high blood levels. The only solid way to correlate titers to protection is with challenge studies, and again for almost all the other vaccines other than rabies, this has not been tested thoroughly. Every vaccine for a disease and manufacturer's product requires its own specific titer studies, to establish the safe titer protection levels.

The titer testing being done presently in clinics to test dogs and cats to see if they need additional vaccine protection are not being done on all the vaccines recommended, and are not proven by a challenge study .Even with rabies vaccines, that do have good long term challenge studies, you still can't just test patient titers to reduce regular recommended vaccine intervals. The state laws won't let you. The department of agriculture won't risk titers when it comes to rabies vaccine, again because of the lethal human implications.

So why avoid the recommended vaccine protocols presently being used when very few pets are proven to suffer prolonged or serious side effects as a result of them, the vaccines are working well, and the titers being run to evaluate protection durations are not tested to be meaningful yet. The titer values presently used to decide vaccine protection are at best an extrapolation and more often a guess.

Another point made about titers is that there are generally two responses by a body's immune system to vaccines. One is humoral response, and the other is cellular. The humoral response is detected with the use of titers. The cellular response is not. Some diseases are best defeated by the body with this cellular response more so than to the humoral response. Again titers can not measure cellular immunity levels or the ability of the immune system to respond to diseases in this way. They do not replace or equate to good challenge studies, the gold standard of vaccine protection to a disease.

We are not having failures of the vaccine to do what they were designed to do; in fact they have been working splendidly. In addition the titers people are requesting are more expensive to obtain than the vaccines themselves being tested, they require a blood sampling procedure and turn around times, and don't even test all the vaccines that are recommended. If the titer levels are low, you will be recommended to revaccinate, thus investing in the cost of the titer testing plus revaccination costs, plus additional visits to the doctor. It's so much more practical just to vaccinate and be safe.

One also has to note that the motivation to recommending titer testing instead of vaccinating may also be financially biased. Although a decline in vaccine income may be the anticipated result when vaccines are administered less often, titer testing can actually increase an animal practice's income.
A recent article in one of the veterinary association's magazines, Trends April 2003, page 14, (American Animal Hospital Association AAHA ) says it best with a quote from one of its articles reporting on an animal hospital that has gone to titer testing exclusively:
……….
"Pricing for success
Next, the computer system had to be updated with new reminder codes and fees to facilitate billing and medical record keeping. Following the recommendations of a practice consultant, Epstein set prices for titers and raised the fees for vaccinations and other services to compensate for the anticipated loss in revenue. 'The biggest fear was that we were going to lose income and clients and that, wasn't the case at all' Says Mary Bryant, VMD. In fact, due to the higher fees and dogs' annual blood work, Wilmington's revenue from lab work rose more than 250 percent between 1995 and 2002."

The higher fees weren't a problem, Epstein says, because Wilmington has a high-quality image. 'Clients know we're expensive, but no more so than some of the corporate-owned practices in the area,' she says. "……. One would hope that their biggest fear was that they were still providing excellent, fair, and affordable pet care, and not a loss of personal revenue by doing what's right medically for their patients! Although their revenues went up 250%, how many fewer clients did they help and send elsewhere or scare away from preventative pet care all together, because of vaccine procedures that cost more, and quite possibly protected less? There was also no mention of any statistical decreases in unnecessary vaccine induced diseases as their profits soared!

Another problem with the "over vaccinating" theory is that there is no solution to the requirements of having to immunization animals to participate in public shows, instructional classes, grooming shops, and boarding kennels. Animal hospitals too require current immunizations; in lieu of the additional exposure hospitalized pets will receive to transmissible diseases coupled with the stress. Here is a portion of the Illinois Animal Welfare Act:

b) No dog or cat shall be accepted for boarding or training unless it has been vaccinated for distemper and proof of such vaccination has been furnished to the kennel operator. (Exemption to distemper vaccination requirement is available upon written recommendation from owner's veterinarian.) Any dog accepted must be in compliance with the rabies vaccination requirements of the Illinois Animal Control Act [510ILCS 5].

Now there are vaccines that are not always indicated or not worthy for use at all. Once again you will find people promoting products and ideas that are not founded. Logic and science don't support their use. What drives their use is fear and greed. Fear generated in those pet owners who want to believe everything they hear, and greed by those who profit from vaccine sales. A good example of this is the "kennel cough" vaccines.

Kennel cough is a catch all term applying to many transient mild upper respiratory diseases in dog and cats. Key here is the word transient. They all get over it by them selves. The multitude of organisms involved is very diverse and similar to forms found in many different host animal species. There are viral, bacterial, chlamydial, and mycoplasma-ureoplasmal type germs that can cause this disease condition. There isn't one vaccine that will protect from all the sub strains not to mention all the species and their possible combinations. We don't even come close to protecting against all the ways to produce a "kennel cough". Why are we concerned? Ask yourself how many cases of death or irreversible damage have occurred from kennel cough. Victims all recover if no other predisposing serious underlying issues are present. The risks of acquiring exposure are very high; the risks of suffering or dying from the disease are extremely low. The overwhelming majority of kennel cough victims have only a transient mild cough. Yet the pharmaceutical producers of this vaccine, and the institutions that profit from vaccine sales, are still requiring or strongly recommending the vaccines use. The modified live vaccines can produce very potent "shedding" individuals that only serve to spread the disease organisms further in public establishments. The vaccine can cause a mild cough itself. They may not be seriously harming patients in the long run, but these are the kind of patients that are being "over vaccinated".

Some individuals have purchased vaccines from wholesale internet sellers, and catalogs in the past, only to discover that the protection from these less expensive sources are not always as efficacious. This was clearly shown to be the case with a large number of Rottweiler breeders not many years ago and a Parvo viral enteritis outbreak that took many dog's lives, while other properly vaccinated animals where protected. Proper vaccination is working currently.

So in general we are living in a culture that has a wide range of opinions on vaccination protocols for pets. Most of the opinion professed is untested or unproven. The facts are that the people who avoid all vaccine, or reduce the recommended booster frequencies, want to scare owners into thinking epidemic numbers of pets are now suffering from new vaccine induced diseases, or that they just plain are getting more than they need, and wasting their money based on titer tests alone. The other extremes of people in our culture want to vaccinate every pet with every available vaccine because of unfounded fear, or the feeling if some is good, more must be better. Individuals who profit from these fears are the people who recommend and sell the vaccines.

One last point about the technology of immunizations is that it's constantly changing as new knowledge and developments occur. For example, we now only immunize feline patients for rabies disease in the right hip sight under the skin. It was found that the tumor producing side effects of vaccines in cats could be greatly reduced by using this sight. This, required by law immunization, is now once again extremely safe for cats by making this simple learned adjustment. The vaccines themselves are constantly being tested and improved to reduce any unwanted reported side effects. The science is always changing and improving to accommodate newer technologies and conditions. Some vaccinatable diseases thought to be idle in pets are recently being reported again more often, like leptospirosois and its ever changing strains. Newer Diseases like West Nile Virus have to be considered as well for vaccine protection. Horse owners now have an approved working West Nile Vaccine available. Recently publication has indicated that pet dogs and cats were very likely to be the early epidemiologic indicators of terrorist anthrax attack. Veterinarians in urban areas need to aware of the signs of this disease. To date no pet anthrax vaccines are available, but they may be indicated in the future.

The practical and safe approach using logic and science is something different than the extremes of "over vaccinating" or vaccinating with every available or inexpensive vaccine. Hilltop Animal Hospitals' recommendations for pet immunizations are based solely on these principals. Every pet must be vaccinated only after first considering their risk factors, exposure, past vaccine response, life style, geographic location, owner's abilities to comply, the current epidemiological conditions, human risks, and the vaccines availability. Hilltop Animal Hospital is a personable and simple operation. Pet owners and their needs get closely monitored. A small cooperative staff and one doctor help to maintain this atmosphere.

Currently Hilltop Animal Hospital uses vaccines that are required by law, vaccines that are only highly recommended by the staff, and vaccines that are less frequently indicated except in specific circumstances. Patients are individually evaluated for their vaccine needs. There are small numbers of animals that react adversely to some vaccines. Patients can usually be pre-medicated first to reduce this problem, and or use a modified vaccine regime to avoid these undesirable reactions. In general cats and dogs and ferrets are offered two classes of immunizations, the recommended core vaccines, and the elective vaccines.

Core immunization includes rabies immunization (a state law) and the various distemper vaccines depending on the species. (Required by most institutions performing public animal services) Vaccinations are scheduled to include a complete physical exam and thorough history on the patient's medical condition and needs prior to immunization. Today these diseases are rarely encountered in urban United States if at all, in vaccinated populations. These vaccines work well.

Elective vaccines are for those animals that are at additional risks or have additional requirements placed on them. Vaccines for Giardia, Lymes, Leptospirosis, Ringworm, Leukemia (FeLV), FIV, FIP, Pneumonitis (Chlamydia), Parainfluenza, Rhinopeumonitis, Calici, Hepatitis, Corona, Parvo, and Bordetella diseases are available when indicated. Other immunizations for staphylococcus bacterial infections and hookworm have also been developed for animals for very specific situations.

The staff and Dr. Hinkle should be able to direct your efforts when considering immunizations for your pet. Preventative and safe vaccine protocols are routinely performed at Hilltop Animal Hospital. Minimal adverse effects are seen, and overwhelming protection rates have been achieved.

There are commercial vaccines available for pet birds, but these are rarely indicated or recommended for the single aviary pet. Reptile or other small mammalian pets are not considered for routine vaccine protection at this time.