March 4, 2010
The low cost of companion animal vaccines has translated into high client compliance, and up to one-fourth of global animal health product revenue comes from vaccines.
But things get complicated when veterinarians use vaccines in ways not approved by the U.S. Department of Agriculture or as recommended by the manufacturer.
Many manufacturer labels recommend that core vaccinations be given every year, but some veterinarians are administering them every three years.
“It’s absolutely possible that the vaccines work for much longer, but the companies have not done the tests to prove that and have no legal or financial motivation to do so,” says Kate E. Creevy, DVM, MS, Dipl. ACVIM, an assistant professor at the University of Georgia.
Federal law gives veterinarians some leeway under certain circumstances.
“Please realize that every time we do that [booster less than annually] we are technically out of compliance with the legal use of the vaccine in question,” Dr. Creevy says. “To be covered under the federal exception, we must have an established veterinarian-client relationship and must explain this extralabel use to the client. Thus, there are still veterinarians who do not feel comfortable doing that.”
To help ease confusion over what constitutes a rational vaccine protocol, the American Animal Hospital Association’s Canine Vaccine Task Force is collaborating to revise the 2006 guidelines, make new recommendations and address key vaccine controversies.
“The list for licensed vaccines for dogs and cats is large and diverse, with about 110 available canine and 70 feline vaccines to choose from,” says Richard B. Ford, DVM, MS, Dipl. ACVIM and ACVPM, a task force member. “Veterinarians want to know how their colleagues are making vaccine selections, the difference between modified-live vaccines over killed and recombinant vaccines compared to killed and modified-live vaccines.”
Dr. Ford says he anticipates the canine vaccine guidelines being released this spring. A frequently asked questions (FAQs) section will address such issues as the anticipated four-way leptospirosis vaccine and the efficacy of Lyme disease vaccines.
“The FAQs is a new section to the guidelines and discusses questions that have surfaced over the last few years,” Ford says. “We are also discussing canine influenza (H3N8) and Lyme disease bivalent as non-core vaccines. In addition to making recommendations about vaccinations, we are making non-recommendations, suggesting veterinarians do not use certain vaccines. With new viral concerns, the shelter medicine section will see some updates as well.”
The canine influenza vaccine has a conditional release and is expected to have full release by year’s end.
General vaccine titers aren’t recommended by the AAHA or the American Association of Feline Practitioners because of their limited need, Ford says.
“Vaccine titers largely are for veterinarians who don’t trust the three-year recommendation,” Ford says. “Titers are usually high but are only valid for certain vaccines. I’d say a good use of titers would be for dogs that had a previous bad reaction to vaccines. A high titer would mean revaccinating was unnecessary. Antibody titers for leptospirosis or coronavirus are not a good indicator for protection.”
Experts say having a discussion with clients about the vaccines being given is a veterinarian’s obligation and necessary for best compliance.
“Owners are communicating with their veterinarians more now than ever about medical recommendations they read online, and expect their practitioner to support his or her recommendations over the other,” Ford says.
“Some owners will say, ‘I don’t vaccinate my child every year. Why should I vaccinate my dog?’ and a veterinarian needs to be able to adequately answer that. Most clients don’t want all of the in-depth detail, but they do want some insight.”
Task force member Link V. Welborn, DVM, of North Bay Animal and Bird Hospital in Tampa, Fla., says vaccines should be thought of as medications—use as little as possible to accomplish what’s needed.
“Frequency is always a topic of discussion,” says Dr. Welborn, a past AAHA president. “Veterinarians should only give a patient a vaccine if he or she feels the animal will benefit. Every client won’t be interested in having a titer due to the cost, among other reasons, and some clients would rather have the vaccine given than pay for a titer, then possibly pay for the vaccine on top of that. Largely, titers aren’t offered.”
Using vaccines as a way to get clients to make an office visit is good medicine, Ford says.
“There are many non-core vaccines that may be necessary for the patient, and evaluating animals annually is smart,” Ford says. “The annual visit gives veterinarians the chance to catch any medical problems.”
Overall, many life-threatening diseases can be addressed through vaccines.
“Veterinarians are continually trying to create preventive health measures to keep pets well, at home and living longer,” Creevy says. “All attempts to vaccinate—even with plans that later have proven to be suboptimal—have shared the goal.
“I think we can and will continue to improve our ability to make vaccine recommendations based on scientific data. This will come from our growing experience with the use of titers and the epidemiologic data we will be able to evaluate after several years of practice of the recommendations.”
This article first appeared in the March 2010 issue of Veterinary Practice News
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