Developing a vaccine strategy

Who would have guessed that the great debate of this decade would focus on vaccine protocols?

In an era of CT, MRI, ultrasound and the advent of numerous sophisticated medical techniques, we are now squarely back to basics.

Prior to writing this column, I posted questions on the AVMA's NOAH and talked to numerous practitioners to seek a consensus on vaccine strategies.

What did I find? There still is no consensus.

Vaccine trauma syndrome (VTS) arrived to upset our smooth-sailing, preventive health-care plans — a peace we enjoyed for decades.

And still we don't seem to be able to tell accurately the relative incidence in cases. At least we have a ballpark figure with feline vaccine-associated sarcoma.

The ever more educated public (coupled with the information coming from within the profession) is asking key questions, like "Now what?"

The whole issue of vaccination frequency has us divided on one issue we all used to agree on — the need to protect our patients from life-threatening disease.

There always have been several approaches to fix broken legs, treat colic and treat parvovirus infections.

Orthopedic cerclage wires were once forbidden, but now with specific guidelines on application they work nicely. The same goes for KE devices.

Digoxin used to be the cure-all for all cardiac disease, but now we use bunches of enalapril and benezapril.

Cancer used to be managed; now we think about changing prognosis.

Pain was always a sidebar discussion, but now we get into heated debates about which painkillers are best. We are attempting to quantify a subjective issue. (Now that is frustrating.)

We all agreed and recommended: "Get those annual vaccines."

As we look at the debate, we see that leaders within our profession cannot come to a universally accepted policy.

How do you tell the owner of a dog who has not been receiving parvovirus vaccines in recent years about a confirmed-positive pet? Are they even receptive to the information?

How do you talk to a client about her 10-year-old dog that has atypical distemper meningitis, yet showed distemper titers two months ago?

How do we retrain clients to rethink annual vaccines when we have pounded the message into their minds for years? This debate ends up in a cauldron of unresolved topics.

Leptospirosis vaccination might not be popular in some areas, yet leptospirosis is an issue in certain places and communities.

And if the recommendation is to "adapt the vaccine recommendations to your situation," how should we implement that concept?

So, like good soldiers, we go about developing individual practice vaccine protocols. But, like many things in life, unexpected events happen along the way. They are called unintended consequences of intended actions.

The reality for our practices is that we just do not have enough data to guide our individual clients. The key message: We need to start gathering it.

Further, it seems prudent to interview each client about their situation and their desires. Talk about the vaccines. Talk about efficacy and safety. Talk about diseases of utmost concern in your community.

Think about what you and your hospital staff are going to say to a client with a 10-year-old dog who, following a three-year presentation, says to the receptionist on the way out: "I want the distemper/parvo vaccine annually. Last year we had a dog die of parvovirus in the neighborhood."

Sometimes the local veterinary diagnostic laboratory services can help us with information gathering as to the relative incidence of various conditions for our area.

Each of us must begin gathering incidence data in our practices. What type of recommendations will you provide for feline FIV testing and vaccination when the practice had one confirmed illness the previous year?

For years parvovirus persisted as a leading killer, but what do practitioners recommend when respiratory diseases take over as a leading killer?

Put strategy in motion

Take these steps to improve vaccination discussions.

1. Set up a marketing plan to gather client data and provide education to the staff and clients.

2. Review local disease issues with colleagues and the diagnostic services.

3. Get a solid diagnosis. More than ever we need more accurate diagnostic data. Perform more necropsies; take more biopsies; ask more questions.

4. Keep an open mind. Consider new information but move carefully to abandon the old, as the information and products coming our way are moving targets. Spend three years modifying and implementing a vaccine-protocol change. Then adjust it annually to fit your locale and client base.

5. Read more. Why? Practices are performing real medicine. You need to stay current.

6. Prepare a client questionnaire, vaccine discussion sheet. (Refer to the Canine Vaccine Discussion Worksheet on) Some elements could include:

a) Gather pet data with individual client interviews at annual visits.

b) Keep the survey to one page.

c) Briefly discuss the diseases.

d) Outline recommendations for young dogs.

e) Provide recommendations for geriatric dogs.

f) Keep notes in a provided box on client situation.

g) Use the back as a release form.

h) Photocopy this page and discussion for the client's personal medical record.

Click to enlarge

Michael H. Riegger

Dr. Riegger, dipl. ABVP, is the chief medical officer at Northwest Animal Clinic Hospital and Specialty Practice. Contact him at www.northwestanimalclinic.com, Riegger@aol.com telephone and fax (505) 898-0407. Find him on AVMA's NOAH as the practice management moderator. Order his books "Management for Results" and "More Management for Results" by calling (505) 898-1491.