Much ado about nothing?

If there's controversy among veterinarians over the release of the American Animal Hospital Association's canine vaccine guidelines, Dr. Michael Paul has yet to receive wind of it.

Table 1.

As chair of the taskforce for the recently published guidelines, Paul says he was shocked by the lack of reaction.

"By and large, it's been almost a nonevent," says Paul, who presented material on the guidelines at the 70th annual AAHA conference in March.

"It's my humble opinion that veterinarians were ready for this. The profession was fearful of it, but I think they've come to realize the only thing you can do is accept what's been said and either adopt or not adopt. The reality is that when people have had a chance to digest it, they have not been so terribly upset about it."

What AAHA endorses

At the presentation Paul said the taskforce endorses a handful of items:

• Extended duration of immunity

• Vaccines divided into categories of "recommended," "optional based on individual," and "not recommended."

• Tailored vaccine programs

• Thorough discussion with client, informed consent.

• Reporting of adverse events

Dr. Jay Geasling says he'd be shocked if people disagreed. "I think the guidelines are fair and appropriate. They're not radical. They make sense."

Timing of essence

AAHA's report was preceded by the American Veterinary Medical Association's Council on Biologic and Therapeutic Agents broader vaccine report issued in 2002. The American Association of Feline Practitioners released feline-specific guidelines in 1998. (See "Primed for Protocols" article in April issue of DVM Newsmagazine.)

"The reason AAHA chose to limit the guidelines to canine species is that the dogs don't have a group to speak for them," says Paul.

"This was probably much more a controversy a year ago than it is anymore. People have been exposed to AVMA guidelines and certainly live with the AAFP guidelines," he adds.

Dr. Earl Cornprobst says he instituted new guidelines for felines last summer and accepted dog recommendations just prior to the conference. "I've been wishing for this. That got the doctors in our practice a little irritated but once they were released, no one had issues," he says.

On other side

Dr. Cheryl Chappa, first-time AAHA attendee, while somewhat supportive, has her concerns. "I'm not surprised by the guidelines, but I'm also not ready to accept them. No one's going to protect me when the vaccine protocol fails. Industry won't be there. Someone's got to convince the vaccine companies they're going to have to change."

In part, she's right. As of now, AAHA says it is the responsibility of veterinarians to report any adverse reactions to vaccines to the manufacturers. Contact information and phone numbers for reporting are included on AAHA's Web site. And they concede that veterinarians won't be immune to legal issues, as with any medical action.

The best advice, says Paul, is to talk to your clients. "AAHA endorses informed consent, thorough discussions. Document talks and decision. Consult malpractice attorneys."

Post-conference call

A week after the conference, AAHA expected at least marginal backlash when it sponsored an audio conference call.

Nearly 100 practices and close to 800 staff members participated. They fielded just two questions. Both were informational.

"Partly, I think this is because AAHA went to great pains not to make this prescriptive guidelines. We did not say thou shalt not do this," Paul says.

Bottom line

The overriding goal of the guidelines, AAHA emphasizes, is to provide veterinarians with information to help them develop customized vaccine programs and appropriate care for their patients. Because AAHA acknowledges a paucity of scientifically documented, published evidence supporting minimum duration of immunity, the association stresses that their guides are based on expert opinion and consensus opinion.

"It's my belief that these guidelines are going to encourage the practice of better medicine, because veterinarians will have more time to spend on medicine instead of dealing in a commodity," says Paul.

In works

Beyond the rollout and implementation period for the guidelines, the taskforce is now currently trying to secure the endorsement of two other specialty organizations of which Paul declined to name. "The idea is that much like AAFP sought endorsement, we want to seek the endorsement of other specialty groups," he says.