Introduction. .2
HealthGenes Pre/Post Vaccination Program ... ..3
What About Other Vaccines Besides Parvovirus and Distemper virus? ..... .3
Comprehensive Individualized Care .. 4
Assessing Individual Needs .. .5
Post Vaccine Evaluation.. .. 6
Conclusion... 7
Appendix A ..8
Appendix B ..9
Appendix C 10
Appendix D 11
Appendix E 12
Glossary... ..13
References ..15
Among dog caretakers few topics are more debated than vaccination. Many dog owners have concerns about over-vaccination due mostly to information they gather from the Internet, radio, television or numerous other publications. This has put increased stress on veterinarians regarding vaccination. At this point there is no universally accepted standard vaccine protocol to turn to. Even so vaccination is a medical decision and a medical procedure that should be individualized based on the risk and lifestyle of the individual animal1. An evolution in vaccination programs for dogs has been started and is underway. The duration of immunity that particular vaccines provide can last many years2, and the practice of revaccinating dogs annually with all vaccines is changing. An increasing number of researchers and experts recommend that vaccines offering long-term immunity can and ought to be administered no more than every three years. However this raises other issues for veterinarians. If dogs are not vaccinated on a yearly basis, clients may see no reason to bring the patient to the practice on an annual basis. Veterinarians must now justify why its necessary to change the recommendations they have made for so many years and back it up with scientific fact. If practitioners are going to vaccinate patients less frequently, they need a way to evaluate immunity on an individual basis and to be confident in their recommendations. Another concern will be differentiating between actual infection and previous vaccination or exposure.
Decades-old guidelines called for dogs to be vaccinated annually. This is understandable since vaccines have helped prevent and in some cases eliminate disease and suffering. However, duration of immunity-especially for the most essential vaccines-often lasts much longer than one year2. If the animal already has immunity and is subsequently vaccinated it can experience an Adverse Reaction* or Serious Adverse Reaction (SAR). The most common clinical signs recorded for vaccine SARs in dogs are systemic, digestive, neurological and skin disorders3. It is interesting to note that young animalsS are over-represented with respect to vaccine SARs since 47.2% of dog vaccine SARs reported were in animals less than six months of age3. Some of these apparent reactions may be due to coincidental infection with field viruses3. A risk/benefit assessment should be made for each individual animal by the veterinary staff in consultation with the owner so that, if required, an informed choice may be made by the owner with respect to the necessity for a particular vaccine and the frequency of its use. The assessment should include discussion on the likelihood of exposure, available data on duration of immunity, and the risks related to vaccination3. HealthGenes Canine Pre-Vaccination Program should help facilitate such decision-making, which can be made easy with HealthGenes decision-making tree.
HealthGenes Pre/Post-Vaccination Program
HealthGenes Pre/Post-Vaccination Program consists of two components which can be used to fully asses the immunity and infection status of the dog. The first component is a DNA Profile which includes Canine Parvovirus (CPV-2) and Canine Distemper Virus (CDV). The second component is an Antibody Titer Profile which includes Canine Parvovirus (CPV-2) and Canine Distemper Virus (CDV). The CPV-2 and CDV DNA profile is used to determine the infectious status of the dog. Previous vaccination or exposure will not interfere with the DNA test because it does not detect antibodies. A positive result means that the dog is infected. A negative result means that the dog is not infected. The CPV-2 and CDV Antibody Titer Profile is used to determine the dogs immunity. A high antibody level correlates with protection from infection and/or protection from disease1. A low or none existent antibody titer may be susceptible to infection and disease1. These profiles can be used together as a package to obtain a full immune status report of the animal.
What About Other Vaccines Besides Parvovirus and Distemper virus?
It is impractical and expensive to determine the immune status against every vaccinated disease. The two most serious canine diseases, based on their severity and the percentage of dogs that die from them are CPV-2 and CDV. Determining the immune status for CPV-2 and CDV is an excellent way of monitoring general immunity1. A DNA test can be used to determine infection and a titer test for immunity. In most cases the majority of dogs that do, in fact, develop a response to CPV-2 and CDV will also develop an immune response to the other important vaccines in a combination product. Also, antibody plays a key role in protection for CPV-2 and CDV and can provide sterilizing immunity. Antibody levels for other vaccines have limited or no value because antibodies persist for a short period of time. Often no correlation between serum antibody and protection can be made1. These vaccines are considered non-core and given annually to dogs determined at risk. If infection is suspected a DNA test could be done before vaccination to avoid adverse reaction for these non-core vaccines. Law controls rabies vaccination and the vaccine is known to be effective for three years.
Comprehensive Individualized Care
As mentioned above, there is no universally accepted standard vaccine protocol. However, differences in risk of exposure to infectious diseases, age and health of the patient, and potential side effects of certain vaccines make it next to impossible to recommend one single vaccination protocol for all dogs. The Canadian Food Inspection Agency recommends that the veterinarian reflect the needs of the individual animal and tailor the protocol accordingly4. The Department for Environment Food & Rural Affairs in the UK made the following statement A risk/benefit assessment should be made for each individual animal by the veterinary surgeon in consultation with the owner so that, if required, an informed choice may be made by the owner with respect to the necessity for a particular vaccine and the frequency of its use3. The 2006 report of the American Animal Hospital Association (AAHA) wrote, Every patients vaccination needs should be assessed at least yearly. The practitioner should explain to the client the types of vaccines available, their potential benefits and risks, and their applicability to the particular dog, given its lifestyle and risk of exposure1. It further states that Vaccination is a medical decision and a medical procedure that should be individualized based on the risk and lifestyle of the individual animal1. The experts agree that a comprehensive individualized vaccination program for each animal is needed. HealthGenes pre/post-vaccination program is a reliable tool that can be used to tailor vaccination needs to individual patients and made easy with HealthGenes decision tree.
Every patient is different. Age* , breed, health status, environment, lifestyle and travel are only some of the diverse reasons why an individualized program is needed. Sometimes the history is known and sometimes it is not known. If history is not known, the infectious status should be determined first. Infection can be determined with a DNA test. If the DNA test is positive, vaccination would be of no use and may even cause an adverse reaction. If the DNA test is negative, an antibody titer should be used to determine previous vaccination or exposure. If the dogs titer level is high, vaccination should not be expected to boost immunity and may cause hypersensitivity or an adverse reaction. A high titer level has the same capacity for maintaining a healthy immune response, regardless of whether vaccine is given. Protection as indicated by a positive titer result is not likely to suddenly drop off unless an animal develops a medical problem such as cancer and receives immunosuppressive drugs. If the dogs titer level is low, it may be susceptible to infection. Dogs with low titer levels should benefit from vaccination. Depending on the titer level, the animal may simply need a booster to stimulate a stronger immune response. Some argue that a negative titer test does not mean the animal would develop disease if exposed and therefore a negative titer is useless information. However it has been demonstrated that antibodies correlate with protection from infection and/or protection from disease1. Under experimental study antibody-positive animals remained healthy after challenge with virulent strains of the viruses and unvaccinated control dogs became infected; some dogs developed the disease and died1. The 2006 report of the American Animal Hospital Association (AAHA) states, When antibody is absent it should be assumed the animal may be susceptible to disease and therefore should be revaccinated1. The bottom line is simple; more information facilitates better decision-making. Once the animals immune status has been established, or if its previous history was known, annual titer check-ups would be sufficient to determine vaccination needs. These annual Post Vaccine Evaluation sessions will be discussed in our next section.
Post Vaccine Evaluation is an ongoing and important part of HealthGenes Pre/Post Vaccination Program. The Post Vaccine evaluation part of the program will solve one of the biggest threats posed as veterinarians move from annual vaccinations to vaccinating every three years. If veterinarians are to stop vaccinating every year the client will see no reason to bring the patient to the practice on an annual basis. Veterinarians are justifiably concerned that a reduction in vaccination frequency will cause clients to forgo routine annual visits for their dogs and that the qualities of care animals receive will be diminished. HealthGenes Post Vaccine Evaluation System will offer veterinarians an opportunity to determine antibody protection annually so they can be confident about the animals immune status. These regularly scheduled appointments will help facilitate the integration of annual health evaluations. These comprehensive individualized health evaluations should include physical check-ups, dental care, proper nutrition, appropriate diagnostic testingS , parasite control* and zoonotic diseases1+ . The veterinarian can then discuss the vaccination needs with the client and any other finding during the check-up. A reminder card can be sent out each year notifying the client that their dogs yearly Post-Vaccination assessment and health exam is due. This comprehensive individualized approach is focused on the welfare of the animal and will help prevent both disease and reaction. Passing this knowledge to the dog caretakers will help them feel more confident in their pets healthcare opportunities.
Vaccine schedules are changing and concerns about over-vaccination are growing. With no universally accepted standard vaccine protocol to turn to, veterinarians need a system they can use to make rational decisions. Age, breed, health status, environment, lifestyle and travel make individualized vaccination programs a necessity. As yearly vaccination diminishes, veterinarians begin to see animals less often and late detection of disease and health troubles become a new problem. HealthGenes Pre/Post Vaccination Program is a reliable tool that can be used to tailor vaccination needs to individual patients. It also provides a wealth of information to veterinarians about the immune status of the animal even if previous history is not known. Both infectious status and immunity can be determined with the program leaving no guesswork. HealthGenes post vaccination system will help facilitate annual visits and routine check-ups promoting pro-active healthcare. This will become the most important matter as veterinarians move towards tri-annual vaccination.
Adverse Reactions associated with Vaccines
Allergic Dermatitis
Allergies
Anaphylactic Shock
Angioedema
Asthma
Autoimmune thyroiditis
Glomerulonephritis
Hypothyrodism
Immune-mediated hemolytic anemia
Immune-mediated thrombocytopenia
Laryngeal edema
Local Reactions
Mild Systemic reactions
Renal failure
Special Consideration for puppies
Special consideration needs to be given to puppies in regards to vaccination programs. There are a significantly higher proportion of 0-6 month old animals in the vaccine SARs group compared to animals over the age of one year3. Young animals are over-represented with respect to vaccine SARs and 47.2% of dog vaccine SARs were in animals less than six months of age3. Animals less than six months of age will be undergoing a primary course and they may therefore be more susceptible to some types of adverse reactions. Some of these adverse reactions may be due to a coincidental infection with a field virus3. Also, puppies are generally vaccinated at a stage when maternally derived antibody has just waned, leaving them susceptible to field virus infection. A DNA test for CPV and CDV-2 should be use to determine infection. Maternally derived antibody will not interfere with a DNA test. If the DNA test comes back positive, it means the animal has become infected with a field virus. Vaccination at this point would not be recommended. If the DNA test is negative, antibody titers for CPV and CDV-2 can be used to assess maternal antibody titers, follow their decline and determine when to start and stop the vaccination series. On completion of a puppy series at 12 or more weeks of age with products containing CDV and CPV-2, an animal should have an antibody titer and it should test positive. The sample should be collected two or more weeks after vaccination1. If the animal does not have an antibody titer, it should be revaccinated-perhaps using a different product-and then retested. If the titer is again negative, the individual animal should be considered a low responder or a non-responder and possibly incapable of developing a protective antibody titer1. Specific care should be directed toward these animals. Young animals are at greatest risk to infection from CDV and CPV-2, and infections often lead to severe disease and death. A DNA test should be used to determine if the animal is infected with a field virus. This will help avoid unnecessary adverse reactions for positive animals. Antibody titers are useful and recommended as a medical procedure to ensure the animal has developed an immune response after the primary series of vaccinations1.
Wellness Testing
As mentioned in the post Vaccine Evaluation section, appropriate diagnostic testing should be included in annual health check-ups. Wellness testing refers to checking all the internal body functions for changes in blood parameters and organ function. Animals instinctively hide signs of illness and this can allow for early detection of diseases before symptoms are present. Therefore, treatment can be administered earlier and may slow down the progression of disease. If the blood work is normal, it can be used as a baseline for future testing. Wellness testing will help create a comprehensive individualized healthcare program and facilitate early disease detection.
For more information on HealthGenes Wellness testing please call 1-877-371-1551 and ask for HealthGenes education department.
Help Control The Heartworm Parasite with a DNA test
As mentioned in the Post Vaccine Evaluation section of this report, it is important to include parasite control with annual vaccine reevaluation. However this poses a unique problem to those clinics in areas with specific heartworm seasons (mostly in the spring) due to the environment, heartworm life cycle and current testing methods. Vaccination sessions are spread throughout the year, and having the customer come back at a future date to do a heartworm test is both inconvenient and risky. To avoid this, HealthGene provides its customers with year round heartworm testing. This is possible because of HealthGenes advanced DNA technology. A DNA test can be used for year round testing because it detects the actual organism, not the bodys response to it. Also, the genetic code of the heartworm does not change throughout its structural transformation. The heartworm organism (Dirofilaria immitis) is a multi-celled organism that is quite large in comparison to other infectious pathogens regardless of its life cycle. Once the larvae are inserted into their host they begin to mature and change structurally, shedding genetic material into the blood stream, creating an ideal situation for a DNA test. By combining Heartworm DNA testing with Post-Vaccination sessions, a clinic can spread its customer volume and revenue evenly throughout the year. This system will help retain clients and facilitate convenience and better customer service.
If you would like to introduce Heartworm DNA testing to your clinic please call 1-877-371-1551 and ask for HealthGenes education department. You will be provided with your very own starter kit, which includes a Heartworm DNA information package, signage, and staff training.
Controlling Zoonotic Infections
As mentioned in the Post-Vaccination section, zoonotic disease should be discussed during the post vaccination evaluation. Although healthy people can become infected with zoonotic diseases, the people most susceptible to these types of infections are small children, the elderly and those with suppressed immune systems. HealthGenes Family Protection Health Program is a preventative initiative, designed to detect carriers of infection. HealthGenes Canine Zoonotic Profile has been designed specifically for dogs, and can be offered to at risk or interested clients. This profile includes the most common harmful pathogens which can be passed from the dog to humans. Having zoonotic testing readily available will help veterinarians provide a full service to clients.
If you would like to introduce zoonotic testing to your clinic please call 1-877-371-1551 and ask for HealthGenes education department. You will be provided with a Family Protection Health Program Guide, Flyers (available for dogs, cats and birds), poster and free staff training.
Adverse Reaction: Adverse reaction means a reaction which is harmful and unintended and which occurs at doses normally used in animals for the prophylaxis, diagnosis or treatment of disease or the modification of physiological function5.
Anaphylactic Shock: A severe and sometimes life-threatening immune system reaction to an antigen that a person has been previously exposed to. The reaction may include itchy skin, edema, collapsed blood vessels, fainting, and difficulty in breathing6.
Angioedema: Angioedema is a swelling similar to urticaria (hives), but the swelling is beneath the skin rather than on the surface. The swellings are called welts. The welts usually occur around the eyes and lips. They may also be found on the hands, feet, and throat. Angioedema can result from certain allergies7.
Canine Parvovirus: A virus causing acute disease involving fever, diarrhea, vomiting and death in dogs3.
Challenge (of vaccine): To expose animals to a substance or virus to test immunity3.
Core Vaccines: Core Vaccines are those that all dogs should receive in one form or other1.
Dermatitis: Inflammation of the skin characterized by eruption of itching papules, vesicles and lesions resembling hives, typically in clusters8.
Duration of immunity: Refers to the duration of detectable humoral or cell-mediated immune response. Not to be confused with duration of protection3.
Duration of protection: Refers to the length of time following vaccination that an animal is protected against challenge3.
Edema: Swelling from excessive accumulation of watery fluid in cells, tissues, or serous cavities9.
Glomerulonephritis: Inflammation of the kidney10.
Hemolytic anemia: Anemia resulting from destruction of erythrocytes9.
Hypersensitivity: Abnormally susceptible physiologically to a specific agent (as a drug or antigen) 8.
Hypothyrodism: Too little thyroid hormone. Symptoms include weight gain, constipation, dry skin, and sensitivity to the cold. Also called underactive thyroid9.
Maternally derived antibody: Antibody acquired without exposure to the antigen passed mainly in cats and dogs from mother to offspring via colostrum (early milk) 3.
Noncore (or optional) Vaccines: Optional vaccines that are administered selectively; based on the animals geographic area, lifestyle exposure and assessment of risk/benefit ratios1.
Serious Adverse Reaction: Serious Adverse Reaction means an adverse reaction which results in death, is life-threatening, results in significant disability or incapacity, is a congenital anomaly/birth defect, or which results in permanent or prolonged signs in the animals treated7.
Sterilizing immunity: An immune response that completely eliminates an infection11.
Titer: The concentration of a substance in a solution, or the strength of such a substance detected by titration. In the current context, the term refers to antibody titer, which is a measure of the concentration of specific antibodies to selected microbes that are circulating in an individuals bloodstream12.
Thrombocytopenia: A decrease in the normal number of platelets, a substance found in the blood that is necessary to help the blood clot. This condition can cause spontaneous bruising and prolonged bleeding after injury13.
Thyroiditis: inflammation of the thyroid gland9.
Urticaria: A condition in which red, itchy, and swollen areas appear on the skin - usually as an allergic reaction from eating certain foods or taking certain medications14.
Vaccine adverse event: A Vaccine adverse event is any undesirable or unintended outcome (including failure to achieve the desired result) that occurs in conjunction with vaccine administration1.
Zoonotic: A disease, which can be transmitted between animals and people15.
1
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3 Gaskell; Professor Rosalind BVSc, PhD, MRCVS, Chair, Gettinby; Professor George BSc, Dphil, Cstat, Hon Ass RCVS, FRSE, Graham; Mrs Sheila, BSc, & Skilton; Mr. David, BVSc, MRCVS (2001). Final report to the vpc. Veterinary Products Committee (VPC) Working Group on Feline and Canine Vaccination, 2001.
4 McKelvey D (1998). Vaccine Protocol Change Deemed Premature. Canada Veterinary Journal 39, 203-206.
5 EU Directive 81/851 Pharmaceutical legislation. Veterinary Medical Products. Luxembourg: Office for Official Publications of the European Communities, 1998.
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15
(1997-2007). Dictionary of veterinary terms. Retrieved April 18, 2007,
from PetEducation.com Web site: http://www.peteducation.com