Puppy and Kitten Health

Iams Canine Pediatric Care Symposium

Proceedings from a Symposium at the 30th World Congress of the World Small Animal Veterinary Association WSAVA FIAVAC AMMVEPE Mexico City, Mexico 12 May 2005

Reprinted in the IVIS Website with the permission of IAMS

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New Protocols for Canine Vaccination

GOALS OF VACCINATION Patricia E. Rynders, DVM, MS
Division of Laboratory Health College of Veterinary Medicine Auburn University, Auburn, Alabama USA
The ideal vaccine would: always induce immunity induce immunity that is life-long immunize puppies at birth have no risks or side effects be easy to administer be stable under storage Although modern vaccines have advanced in these areas, improvements are still needed in duration of immunity and effective immunization of puppies. Although absolute resistance to disease is an ideal goal, vaccines that merely reduce the severity of disease and the risk of death still provide significant benefit in controlling many conditions.

INTRODUCTION
Vaccination is the process by which an animals immune response to an infectious disease is stimulated by a method, other than developing and living through the disease. This process attempts to render the animal resistant to that disease upon future exposure. Historically, the vaccination process was an easy one. Most veterinarians vaccinated for everything and vaccinated often. However, with the emergence of many new vaccines on the market and the realization that vaccination is not risk free, the process is no longer so simple. Pertinent questions for todays veterinarian and pet owner include: What vaccines are necessary? What is the ideal administration protocol? How effective are vaccines? What are the risks? What is the duration of immunity? Many of the answers to these questions are unknown or poorly understood. But we do know one thing for certain there is no single vaccine protocol that is best for all situations. Veterinarians must educate owners and assist them in determining if the risks of various vaccine options are worth the potential benefit to their puppies and dogs and their particular needs.

TYPES OF VACCINES
Modern vaccine technology has allowed the production of vaccines in a variety of different forms, each with its own applications, benefits, and disadvantages. In general, these different forms have been developed to minimize induction of disease, increase the spectrum and duration of immunity, improve handling and storage, and minimize side effects. Killed vaccines and bacterins (vaccines for bacterial diseases) are generally safe but must often be boosted by adjuvants. Often, they are not as effective as other forms and require repeated or more frequent vaccination to induce or maintain immunity. In addition, the adjuvants can create problems. Modified live virus (MLV) vaccines generally produce rapid and prolonged protection and a broader immune response. They are also more effective at immunizing young puppies at an earlier age. The main disadvantages of MLV products include the potential to induce disease and easy inactivation if handled inappropriately. 26
Canine Pediatric Care Symposium WSAVA 2005

Puppies (< _16 weeks)

Most puppies that adequately nurse within 48 hours of birth will receive colostral antibodies from the bitch. This passive transfer of antibodies will provide adequate protection for 616 weeks. This same passive protection also blocks the ability of vaccines to induce immunity in these puppies. To overcome this problem, vaccines are often administered to puppies as a series of inoculations. In general, most vaccinations begin at 68 weeks of age and are continued every three weeks until 14 weeks of age. Some exceptions to this include: intranasal vaccines such as Bordetella which can be given as early as 34 weeks of age, leptospirosis and rabies, which should not be given before 12 weeks of age, and others such as parvovirus, which should be administered through 17 weeks or longer in some breeds. Multiple vaccines can be administered at the same time but vaccines should not be administered more frequently than every two weeks. It is important to remember that even if the ideal protocol is followed, puppies can still be susceptible to disease during this period because of the interference of maternal immunity.

Puppies that are unvaccinated, inappropriately vaccinated or have an unknown vaccination history (>16 weeks)
The protocol depends on the vaccine that is used and the disease being vaccinated against. In many cases, a single vaccination with an MLV product will be protective; however, most products have instructions that require two inoculations at least two weeks apart.

Subunit or recombinant protein vaccines contain only a part of the infectious organism and have the potential to cause fewer side effects, but may not be as antigenic as MLV vaccines.1

Adult Boosters
Determining the ideal protocol for booster vaccinations is an area of debate among veterinarians at this time. Almost all vaccines should be repeated at one year of age to ensure effective immunity; however, frequency of revaccination is dependent upon the duration of immunity (DOI) of the product. This varies greatly between diseases and individual vaccines. Historically, annual revaccination has been recommended for all products; however, this guideline is no longer appropriate. The frequency of vaccination depends on the situation, some may require annual administration, and some may never need to be repeated. See specific recommendations below.

FACTORS TO CONSIDER IN DETERMINING THE NEED FOR A PARTICULAR VACCINE

With todays biotechnology, it is possible to make vaccines for many infectious diseases; however, the ability to produce a vaccine does not make that vaccine necessary. A number of factors must be considered to determine whether a vaccine is appropriate and if it will be effective in controlling the disease in a population of dogs. These factors include 1) the incidence of the disease, 2) the severity of the disease, 3) how easily the disease is transmitted, 4) the effectiveness of the vaccine, and 5) public health concerns. In addition, factors such as age, geographic location, travel potential, housing, and likelihood of exposure must also be considered in determining whether a vaccine is appropriate for an individual dog.

Breeding Bitches
In most cases, the vaccination protocol for breeding bitches will be similar to any other adult dog. Because maternal antibody levels in puppies reach 6097% of their mothers protective level, it should not be necessary to revaccinate bitches that have received boosters of core vaccines at acceptable intervals. Bitches of questionable vaccination history should be given vaccinations approximately three weeks prior to breeding to ensure passage of maximum protection to their puppies. In general, most vaccines should not be given to pregnant dogs. 27
Canine Pediatric Care Symposium WSAVA 2005

VACCINE PROTOCOLS
The first step in identifying the appropriate vaccination protocol for a canine patient is to determine the susceptibility of the particular dog based on its history.

Orphaned Puppies (did not nurse from bitch during first 48 hours)
Oral administration of hyper-immune serum can be performed up to 72 hours after birth. Administration of passive immunity should be considered if there is known exposure to an infectious disease. Some killed products can be administered earlier than six weeks if needed. Modified live virus vaccines should never be administered earlier than recommended due to the possibility of inducing disease.
Table. Classification of canine vaccines

Unvaccinated or Unknown Vaccination (>16 weeks): Single dose is protective. Second dose in 34 weeks is recommended. Second dose is required if using killed vaccine. Adult Boosters: At one year of age then every three years. Parvovirus MLV recommended Initial Puppy Vaccination (< _16 weeks): Begin at 68 weeks, vaccinate every three weeks until 1214 weeks of age. Additional vaccinations through 1618 weeks are recommended with MLV. Additional doses are required if using killed vaccine. Vaccination until 18 weeks of age is also recommended for Doberman Pinschers, Rottweilers, and some Labradors. Unvaccinated or Unknown Vaccination (>16 weeks): Single dose is protective. Second dose in 34 weeks is recommended. Second dose is required if using killed vaccine. Adult Boosters: At one year of age then every three years for MLV. Yearly with killed product. Rabies Killed vaccine recommended. NOTE: LOCAL LAWS REGARDING RABIES VACCINATION MUST BE FOLLOWED Initial Puppy Vaccination (< _16 weeks): Single vaccination after three months (12 weeks) of age. Unvaccinated or Unknown Vaccination (>16 weeks): Single vaccination. Adult Boosters: At one year of age then every 13 years depending on product and local laws. Note: Local laws may dictate that this vaccine may only be given by a licensed veterinarian.

Core Vaccines
Distemper Hepatitus (Adenovirus Type 2) Parvovirus Rabies

Non-Core Vaccines
Measles Parainfluenza Leptospirosis Bordetella Lymes Coronavirus Giardia

VACCINE RECOMMENDATIONS*
Due to the multitude of vaccines currently available and the recognition that not all vaccines are appropriate for all dogs, a number of task forces and individual experts in this area of veterinary medicine have developed guidelines to assist veterinarians and dog owners with this issue (Table).2-4 As a result, vaccines have been divided into two categories: core vaccines and non-core vaccines. 1. CORE VACCINES Generally Recommended for All Dogs Distemper MLV recommended Initial Puppy Vaccination (< _16 weeks): Begin at 68 weeks, vaccinate every three weeks until 1214 weeks of age. Unvaccinated or Unknown Vaccination (>16 weeks): Single dose is protective. Second dose in 24 weeks is recommended. Adult Boosters: At one year of age then every three years. Hepatitis MLV recommended. Use Adenovirus-2 only. Do NOT use Adenovirus-1. Initial Puppy Vaccination (< _16 weeks): Begin at 68 weeks, vaccinate every three weeks until 1214 weeks of age.

2. NON-CORE (OPTIONAL) VACCINES Should be Considered in Special Circumstances That Are Usually Dependent Upon Individual Risk of Exposure Measles MLV recommended Initial Puppy Vaccination (< _16 weeks): Single dose between 412 weeks only. Parainfluenza MLV (injectable or topical intranasal) recommended Initial Puppy Vaccination (< _16 weeks): Begin at 68 weeks, vaccinate every three weeks until 1214 weeks of age. Unvaccinated or Unknown Vaccination (>16 weeks): Single dose is protective. Adult Booster: At one year of age then every three years. Leptospirosis Killed bacterin (various serovars) Initial Puppy Vaccination (< _16 weeks): Administer at 12 weeks and 1416 weeks of age.

*These recommendations do not cover all vaccine products that are available. Many products contain a combination of vaccines that may alter the method and/or frequency of administration. It is important that manufacturers recommendations be reviewed before using any product. Canine Pediatric Care Symposium WSAVA 2005

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 Unvaccinated or Unknown Vaccination (>16 weeks): two doses, 24 weeks apart. Adult Boosters. DOI questionable. If indicated, should be administered at least yearly. May require revaccination every six months in geographical areas with an increased incidence of this disease. Bordetella Killed bacterin, injectable Initial Puppy Vaccination (< _16 weeks): Administer at 68 weeks and 1012 weeks of age. Unvaccinated or Unknown Vaccination (>16 weeks): two doses, 24 weeks apart. Adult Boosters: Annually; more frequently in high-risk settings. Bordetella Live avirulent bacteria, topical intranasal Initial Puppy Vaccination (< _16 weeks): As early as three weeks of age and an additional dose after six weeks age. Unvaccinated or Unknown Vaccination (>16 weeks): A single dose is adequate. Adult Boosters. Annually; more frequently in high-risk settings (every six months or one week prior to exposure). Lymes Killed whole bacterin or recombinant Initial Puppy Vaccination (< _16 weeks): Initial dose can be given at nine weeks but optimal to wait until three months. Second dose in 24 weeks. Unvaccinated or Unknown Vaccination (>16 weeks): two doses, 24 weeks apart. Adult Boosters: Annually, just prior to beginning of tick season. Coronavirus Killed or MLV Initial Puppy Vaccination (< _16 weeks): Begin at 68 weeks, vaccinate every 23 weeks until 12 weeks of age. Unvaccinated or Unknown Vaccination (>16 weeks): Single dose is protective. Second dose in 24 weeks is recommended. Second dose is required if using killed vaccine. Adult Boosters: Annually. Giardia Killed product Initial Puppy Vaccination (< _16 weeks): Initial dose at eight weeks and second dose in 24 weeks. Unvaccinated or Unknown Vaccination (>16 weeks): two doses, 24 weeks apart. Adult Boosters: Annually.

Most commonly, the vaccine is inactivated by the presence of maternal antibodies. Other causes of vaccine failure include: disease or drug-induced immunosuppression, fever, improper storage and handling of vaccine, inactivation by disinfectants, and improper administration. Vaccination during anesthesia or surgery does not appear to inhibit effective immunization.

Vaccine Reactions
It is important to recognize that vaccination is not a benign procedure and a multitude of complications and reactions can occur. These may include: transient local reactions, allergic reactions, fever and malaise, tumor formation, and even death. Fortunately, todays vaccines have a low incidence of side effects, and most that do occur are transient or easily managed. When an individual dog has a reaction, it may be difficult to determine the specific component of the vaccine that is responsible. Subsequent vaccinations should be approached with caution and performed only under the supervision of a veterinarian. Modified live virus vaccines have the potential to create symptoms of the disease or the disease itself. This possibility is augmented when these vaccines are given to animals that are underage, immunosuppressed, or when the vaccine is administered in the incorrect site.

ANTIBODY TITERS TO DETERMINE REVACCINATION INTERVALS

Measuring antibody titers as an indicator for revaccination seems reasonable but is not a simple process. Many factors go into the testing procedure and there is no standardization between testing methods and laboratories. Often, titer levels needed to infer protection from disease are not known. Therefore, it is impossible to know if a given titer in a specific animal indicates adequate protection against disease. In the future, measurement of titers may provide a method of determining intervals for revaccination.

REFERENCES
1. Greene CE. Immunoprophylaxis and Immunotherapy. In: Greene CE, ed. Infectious Diseases of the Dog and Cat, 2nd ed. Philadelphia PA: W.B. Saunders Company, 1998; 717-750. 2. Greene CE, Schultz RD. Canine Vaccinations. Vet Clin North Am Small Anim Pract 2001; 31:473-492. 3. Paul MA, Appel M, Barrett R, Carmichael LE, Clilders H, Cotter S, Davidson A, Ford R, Keil D, Lappin M, Schultz RD, Thacker E, Trumpter JL, Welborn L. Report of the American Animal Hospital Association (AAHA) Canine Vaccine Task Force: Executive summary and 2003 canine vaccine guidelines and recommendations. J Am Anim Hosp Assoc 2003; 39:119-131. 4. Klingborg DJ, Hustead DR, Curry-Galvin EA, Gumley NR, Henry SC, Bain FT, Paul MA, Boothe DM, Blood KS, Huxsoll DL, Reynolds DL, Riddell MG Jr, Reid JS, Short CR. AVMA Council on Biologic and Therapeutic Agents report on cat and dog vaccines.

VACCINE PROBLEMS
Vaccination Failure
Not every attempt to vaccinate a dog is effective and numerous factors can contribute to vaccine failure. Even under the best of circumstances, some vaccines may only be 65% effective. This may be useful in reducing the incidence of disease in a population but can leave a large number of individuals at risk. 29

Canine Pediatric Care Symposium WSAVA 2005