Leading Off: FAQs about vaccines and visits

As I have traveled around the country to make various presentations, I have been gathering FAQs from participants. Two general areas of concern often arise—the best practices for vaccine administration and what to do about declining client visits. Here are my answers to some of the more common questions.

Dr. Michael A. Paul

Vaccination protocols

Q. The vaccination guidelines from the American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP) do not match many of the labels on vaccines. Why is there this inconsistency, and how do I best serve my clients' pets?

Labeled interval instructions are manufacturer-suggested intervals and are really recommendations of minimum duration of immunity. While they might be referred to in a legal proceeding, they are not legally binding directives. These recommendations were, in many cases, developed years ago, and there has been a good deal of discussion about completely eliminating the mention of intervals from labels.

The AAHA and AAFP guidelines are based on scientific studies and expert input. The various guidelines have been widely adopted and have stood the test of clinical as well as scientific examination. In most cases, they have come to be accepted by experts as well as by practicing veterinarians and would be completely defensible in court.

Q. We do not see many animals present with infectious diseases anymore. Why do I still need to vaccinate pets on a routine basis?

The reason we do not see a number of once-common infectious diseases as often is simply because most pets are vaccinated. Once a critical mass of individuals is vaccinated, the ease of transmission is reduced. In areas where there are large numbers of unvaccinated animals, these diseases do persist, but most pets are protected by their vaccination status.

If we see a smaller percentage of protected pets, these diseases will return. So it is vital that we continue to advocate for routine core vaccines and recommend noncore vaccines as indicated by a risk assessment.

Q. In my practice I never see a cat with clinical feline immunodeficiency virus (FIV) infection, but I still test all cats or kittens at their first visit for feline leukemia virus (FeLV) and FIV. If the results are negative and the cat is kept indoors, I do not vaccinate or retest for either disease. Is this a good standard of care?

FIV can be transmitted in utero, so testing kittens is important. However, the disease can also be transmitted at virtually any stage of life through mechanisms such as bite wounds. Cats that spend most of their lives indoors but are let outdoors on occasion can be exposed to infected cats. Even indoor cats are at risk of infection if they live in multicat households where another cat goes outdoors.

The AAFP recommends that all kittens and young adult cats be vaccinated against FeLV regardless of lifestyle. FIV vaccines should be considered in cats that are at risk for exposure, and this conversation should be held with owners with appropriate consideration given to the positive and negative aspects of vaccination.

Q. I cannot remember the last time I diagnosed leptospirosis in a client's dog, so we do not routinely vaccinate for the disease. How do I know if leptospirosis is in my area?

Leptospirosis is often a challenging diagnosis. While improved diagnostics are in development, serologic testing is not routinely performed, so it is hard to determine how many of the patients we see that are empirically treated with antibiotics may be being treated for leptospirosis.

Emerging serovars of leptospirosis are frequently associated with wildlife. Urban wildlife from rodents to coyotes could be infected and serve as reservoirs.

One way of determining a subjective incidence is to contact specialty practices and veterinary schools in your area to learn if and how commonly they are diagnosing the disease.

A risk assessment survey of the owners would reveal lifestyle risks. Any possible exposure to sources of infection should be considered, and dogs deemed to be at risk should be vaccinated yearly against appropriate serovars. All vaccination decisions should be made with input from the pet's owner.

Declining client visits

Q. I have noticed a significant drop in feline visits in my hospital and do not know how to address it. Any suggestions?

This is an industry-wide trend and is due at least in part to the fact that, as a profession, we have not emphasized the need for and value of regular veterinary visits.

Veterinary visits can be stressful for cats and produce anxiety for owners. We must acknowledge that cats and cat owners are different from dogs and dog owners. We need to make our practices more sensitive to this and make it easier and less traumatic to take what appears to be a healthy cat to the veterinarian.

Too often an owner will not see the value in examining a seemingly healthy cat. We need to emphasize the fact that signs of disease can be subtle and cats hide illnesses well. We need to provide a schedule and a facility that make it easier to comply, and we must demonstrate real value to the pet owner.

Every effort should be made to make feline visits as stress-free and comfortable for both the cat and the cat owner as possible. I suggest you implement the AAFP's recommendations to establish a Cat Friendly Practice ( http://catvets.com).

Building a relationship as a trusted adviser and not just as a provider of services is increasingly vital as we differentiate our practices from all others and establish ourselves as the go-to sources of accurate information.

Q. My clients visit me only when there is a crisis and go to vaccine clinics or less expensive facilities for vaccines. It is difficult to maintain a hospital–trained staff and state-of-the-art equipment for complicated cases only. Any suggestions?

Unfortunately as a profession we have not done a good job of emphasizing the value of preventive healthcare and regular veterinary visits. Many pet owners have associated vaccines as the reason they see a veterinarian, and increasingly vaccines have become commodities that are price-sensitive.

We must learn to impart the value of preventive healthcare, which includes vaccination against infectious diseases as one component that rounds out a complete and thorough physical examination, parasite prevention and control, and early detection of disease states.

The Partnership for Pet Preventive Healthcare (http://partnersforhealthypets.org) is a vital source of information to increase the implementation of wellness guidelines and improve pet health. The goal has to be to make preventive healthcare as important as disease treatment.

Increasingly, wellness plans, or preventive healthcare plans, that include vaccination are being developed and marketed. The reality is we need to increase the value perception of preventive healthcare in general.

Michael A. Paul, DVM, has been in the veterinary profession for 40 years in private practice, corporate veterinary medicine, organized medicine, and not-for-profit foundation leadership. He has presented at national and international meetings and is a regular contributor to several publications. He is currently the principal of MAGPIE Veterinary Consulting. He lives in Anguilla, British West Indies.