Market Watch: Risk assessment as a tool for vaccine decisions

Every medical decision, every recommendation, every medical option we present to a client must be based on some parameters—some differentials that represent the value of the options we present. To make a recommendation that has not been well-considered or, just as bad, to not make a recommendation that is valid and appropriate does not serve the pet, the client or the veterinarian. We should always make the best and most appropriate recommendation, or we fail our oath. It is always incumbent upon the veterinarian to discuss the benefits of preventive care and the value of wellness.

Fortunately, we are not asked to make uninformed recommendations. The value and benefit of preventive dental care, surgical sterilization, appropriate nutrition and parasite prevention and control have all been well-documented. And relevant and individually appropriate recommendations are clearly founded and defensible based on a pet's age; lifestyle, including geographic considerations; and objective, physical findings.

Preventive vaccination

One of the most effective and most flexible wellness procedures available to healthcare providers is preventive vaccination. No so long ago, deadly diseases such as canine distemper, canine hepatitis and, more recently, canine parvovirus were rampant and sickened and killed millions of dogs, while feline panleukopenia virus, feline leukemia virus and serious respiratory viruses did the same in cat populations. Today, vaccine technologies have done much to reduce the incidence of these diseases. In fact, some young veterinarians have never seen a case of canine distemper, feline panleukopenia virus or, thankfully, rabies.

Surely much of the pride in the accomplishment of effective prevention goes to our industry allies who have developed, improved and marketed extremely safe and effective vaccines. But not all of the glory goes to industry. Veterinarians witnessed firsthand the suffering and devastation these diseases caused in their communities. They accepted the fact that vaccines at the time were something less than totally effective and somewhat less than risk-free. Had we as a profession waited for everything we have now in vaccines, we would have watched millions of pets die needlessly. As Vince Lombardi said, "Perfection is not attainable. But if we chase perfection, we can catch excellence." And we have some excellent vaccines—not perfect, but excellent.

Core vs. noncore vaccines

Some years ago, amid a flurry of understandable concern over adverse events associated with vaccinations as well as a growing body of evidence that vaccines had a much longer duration of immunity than generally thought, the American Association of Feline Practitioners (AAFP) and American Animal Hospital Association (AAHA) developed vaccination guidelines for dogs and cats. One of the outcomes of these recommendations was the introduction of the concepts of core and noncore vaccines.

Core vaccines are those that should be administered to every dog or cat regardless of lifestyle and risk exposure. Noncore vaccines were intended to be those that were situational and risk-based in their application. Unfortunately, the concept of noncore has come to be interpreted as optional or elective, when, in reality, in some communities and with some risk factors, these noncore vaccines might actually be considered as core in a given individual.

Determining whether a noncore vaccine should be strongly advocated for or not is not an arbitrary decision. Rather, it requires a thorough assessment of the likelihood of exposure and an informed discussion with the pet owner while advocating for vaccines that prevent diseases that may not have the level of morbidity or mortality of a core vaccine—showing owner pet owners that these diseases result in avoidable suffering on the part of the pet and avoidable expense on the part of the pet owner.

Reconsidering "noncore"

If there is a risk and if the available vaccine is effective and safe, then we should become strong proponents of individual noncore vaccines, and, perhaps in some situations, we should elevate them to core status.

For example, if a dog that lives in Florida is kenneled whenever its owner goes on vacation, should it not be routine that the dog be vaccinated against Bordetella species infection and parainfluenza as well as canine influenza? If this pet is thus known to be at significant risk for these respiratory diseases, should they not be considered as core vaccines for that dog?

Or take the instance of a field dog in New England where Lyme disease is endemic. Shouldn't vaccination against Borrelia species infections be considered a core vaccine for that dog?

What about a 4-year-old indoor cat that is prone to fighting and abscesses. Shouldn't that cat's owner be informed and given the option of annual vaccination against feline leukemia virus?

Are you seeing a pattern? Based on the AAFP and AAHA guidelines, every dog and cat is to be vaccinated every three years against the core diseases. By asking a few questions, it is likely that virtually all dogs and cats should receive at least one so-called noncore vaccine every year.

The net results are obvious as well as not so obvious. Animals will be better protected against preventable diseases. More frequent patient visits allow for improved early diagnostic opportunities, more frequent opportunities to inform and educate owners and stress adherence to recommendations and an increased revenue stream for practices. Doctor-patient-client interactions will be more frequent and allow for a better opportunity to build relationships.

Dr. Paul is a veterinary consultant as well as a founding member and former executive director/CEO of the Companion Animal Parasite Council. He has served as president of the American Animal Hospital Association. He now lives in Anguilla in the British West Indies.