Developing individualized vaccine protocols for your practice

Developing vaccination protocols for cats and dogs used to seem like an exercise in futility. But now that the American Animal Hospital Association (AAHA) and the American Veterinary Medical Association (AVMA) have each published vaccination guidelines for these species the exercise has become more rewarding because practitioners can now use this information as a benchmark to tailor a specific program for each patient.

Veterinarians need to develop tailored vaccine schedules to meet the individual needs of their patients.

If you are like me, you changed your feline vaccination protocols a few years ago when the American Association of Feline Practitioners (AAFP) established their recommendations. At that time, you may have also toyed with the idea of changing your canine vaccination schedules as well. We actually did change our canine vaccination recommendations then. It was a brief, brave moment in time. It didn't last. Maybe it didn't last because clients didn't buy into it. Or, maybe my staff didn't wholeheartedly accept it. Or, maybe I put too many caveats on it ("even though the label says yearly", or "Although the vaccine manufacturer probably won't back this", or "You can stay on yearly if you feel your pet would be more protected..."). Most likely all of these affected the fact that most of our clients elected to stay with yearly vaccines. But today many of your clients have heard something from someone or through the news media or online about "over vaccinating" and are making their own decisions. How we handle their inquiries, allay their fears, and overcome their suspicion that we knew this information long before they did and did nothing about it because it would affect our bottom line, will shape our relationship with our clients in the future.

Getting started

To develop vaccination protocols for your practice, start with the information guidelines provided by the AVMA and AAHA. Both of these define core and non-core vaccines. It is also a good idea to research other available information on the subject of vaccines (See Resources, p. 51). Good places to start include DVM Newsmagazine and Compendium. I also like to do searches on the Veterinary Information Network (VIN). This online educational service provides an excellent way to see what your colleagues are doing and saying about vaccinations. Board-certified specialists monitor the discussions, and the conversation can get quite involved. Be sure to also check with the vaccine companies. If you are going to change from the labeled recommendation, it is always wise to know if the company is going to back you to the new industry standard. Then take a good, truthful look at your clients and what they do with their pets. Are you in a rural area with ponds and wildlife? If so, perhaps including the leptospirosis serovars would be advantageous to your patient population. If you live in Connecticut or another area with a high risk of Lyme disease, it would make sense that the Lyme vaccination would be a core vaccine for you. However, if your clients are high-rise apartment dwellers, these vaccines would be on your non-core list. As a matter of fact, you might consider a little Maltese that is treated like a cat and never leaves her apartment, even for walks, may only require vaccines every five years instead of every three years.

Figure 1.

Look also at your geriatric patients. Some veterinarians do not continue to vaccinate after a pet is 7 or 8 years old. Others feel it is important to continue the vaccination series which has been established in their practice throughout a pet's older years. When developing a vaccine protocol for these "senior" patients, I look at their activity level and travel experience. If a dog goes camping or is a frequent participant in a dog sport, I continue their vaccines as I would for a younger dog with the same lifestyle.

Executing your protocols

How do we implement new protocols for our patients? Both AAHA and AVMA guidelines stress that no statement will cover all contingencies nor is only one protocol going to fit all dogs or all cats. The best interest of the patient must, as always, be our priority.

First, all veterinarians in the practice should meet and develop a vaccination philosophy for the practice. You can accept the core and non-core vaccines as described in the guidelines, or you can develop your own list of core and non-core vaccines for the practice. In the areas where your list differs from the published guidelines, ensure that every doctor is in agreement on why you are different. For instance, we decided that Bordetella is a core vaccine for our practice. We see a large number of show, hunting and competition dogs, and many of our clients use a boarding kennel or groomer. We also see several cases of confirmed Bordetella pneumonia every year. We felt that the benefits of the vaccine outweighed the risk. We also elected to use an intranasal vaccine.

Figure 2.

Clear vision

Once this is completed, a meeting with your staff is next. This can be one meeting, if, as with our hospital, the doctors and staff have been discussing the changing role of vaccines for quite some time. It may need to be several shorter meetings if you feel that it is going to take more time for your staff to buy into the new program. In each case, the discussion with your staff needs to be thorough, practical and written down. Find out what clients have been saying to the receptionists on the phone. This is how I discovered that one of the reasons our reminder compliance was down was because some clients had seen a television news report on the dangers of over vaccinating and had decided not to come in for their vaccines this year. They didn't call us, they just ignored our reminders. We had obviously had done an inadequate job of informing our clients of our changed protocols, and their impression was that we didn't know the "latest information." This is a not-so-small, subtle message, which may loom large in the future when that same client has to decide whether we can be trusted to work with his/her pet on a complicated medical or surgical case. In these meetings, veterinarians also need to listen to what your staff says and, more importantly, watch their body language. Do they trust that you know what you are doing? Do they feel their pets are receiving adequate vaccination coverage? Your employees are your internal clients, and if they believe in you, so will your external clients.

Test run

Next, role play the discussions that your staff is going to have with your clients. The receptionists need to be as comfortable discussing the vaccination changes as your technicians. My staff hates to role play. They feel awkward, embarrassed and do everything they can to get out of it. But we still do it. For the vaccination protocol changes, I typed up short "cheat sheets" that answered common questions a client might have to help them start the role play. Soon they discarded my sheets in favor of their own extemporaneous replies, which turned out to be much more graceful than mine.

Clients will come into your practice armed with information regarding the changes in vaccine protocols. It is important to listen to these concerns and provide them with the most current and accurate information available to you and your staff.

Rotating schedule

I recommend developing a protocol that is based on the state-required frequency of rabies vaccination. I live in Ohio where we have a three-year rabies vaccination schedule after a dog or cat is a year of age. The next year, when the dog or cat is 2 years old, we vaccinate with a distemper-based vaccine. I have chosen to use one with distemper, hepatitis, leptospirosis and parainfluenza (DHLP) for adult dogs. For cats, we start in their second year with the feline viral rhinotracheitis, calicivirus and panleukopenia (FVRCP). In the third year, we give the dogs a parvo vaccine, and the cats a feline leukemia vaccine. In the fourth year, they are again due for a rabies vaccine and the cycle begins again. We give a Bordetella vaccine every year to the dogs. Lyme vaccine is only recommended for dogs traveling to known high-risk areas. We carry the additional leptospirosis serovars (a Fort Dodge vaccine) for the owners we have who would like the additional protection and for at-risk dogs that travel to areas known to have a high incidence of those serovars. We may also choose to not include any leptovirus at all for low risk dogs.

Client interaction

More important than our particular choice of vaccines, is the knowledge we impart to our clients. Each client receives a handout to "Help Us Design a Vaccination Protocol for Your Dog," (Figure 1, p. 14) and a similarly titled one for cats. These go briefly, and in lay terms, through why we have modified our vaccination schedules, what a core and non-core vaccine is, and what we recommend. We also review when it might be appropriate to use a non-core vaccine for an individual pet or circumstance. Our clients have been very accepting of our changes, and appreciate the information. Since initiating the changes, we have had a few clients who have interpreted, on their own, the information they have received from the news media to mean they should never vaccinate their dog or cat again, and these clients have steadfastly refused to budge. We offer them our opinion, and then have them sign an informed declination of services. This both covers us and also reinforces to the client that we feel vaccines are still an essential component of the overall health care we provide for their pet.

It is also important that we don't imply that what we are doing today is what we will be recommending tomorrow. The fluid state of medical knowledge causes us to constantly learn and change. As veterinarians, we need our clients to have confidence that we will always keep them informed and that we have access to the latest and the best. We can reinforce our central role in the health of their pet by emphasizing that physical exams are essential and that we can be their main source of information they can trust and understand. One of the ways we can do this is by using the changes in vaccination protocols as a catalyst for a more lasting, bonded relationship with our clients.