Profession should not rely on vaccines as an annual method to see patients

In light of the recently released American Animal Hospital Association (AAHA) Canine Vaccination Guidelines, many questions have arisen among veterinarians and the public in general. Have veterinarians been over-vaccinating and are veterinarians who do not adopt the guidelines guilty of over-vaccinating? The AAHA guidelines were conceived and adopted neither to prescribe a particular protocol nor to establish one protocol as superior to another. The traditional vaccination schedules that veterinarians have been working with and applying in their practices for years are based on years of tradition, a lack of pressing need for change and a widely held perception that the protocols had been based on something once thought of as concrete. In other words, we were working from a narrow perspective based on incomplete information and misunderstanding. The AAHA guidelines as well as the American Association of Feline Practitioners (AAFP) guidelines were developed to provide veterinarians with information to help them adopt the approach that in fact there is no one protocol but rather each individual animal should be vaccinated with consideration of only medical concerns. What is best for each patient?

Need for change

As stated in the AAHA executive summary of the document, the guidelines are based on a combination of expert opinion, clinical experience and published and unpublished support. It is unfortunate, indeed, that there is a paucity of scientifically reviewed published data sufficient to make the guidelines irrefutable. Much of the data considered and many of the observations interpreted in developing the AAHA Guidelines have yet to be published. It is important, however, to recognize that historically applied protocols are largely based on tradition and empirical information. They were initially arbitrary and became traditional. Even today, while there are definite changes in licensing procedures and labeling guidelines being initiated, minimum duration of immunity studies have not been widely applied and maximum duration of immunity studies have not been done nor will they likely ever be performed. The result is that annual revaccination became the norm based primarily on inertia -- a lack of impetus or reason to change.

In human medicine revaccination recommendations are not based on duration of immunity studies or disease challenges. Human recommendations are based on population studies and surveillance systems. Such studies and systems do not exist in veterinary medicine today. However, there is no evidence to indicate that the immune system of a dog and cat responds any differently than the immune systems of their owners. When were you last revaccinated against an infectious disease or a childhood illness? The immune system is capable of an immune memory response well after humeral immunity has waned. The goal in vaccinating an individual is not to prevent infection so much as to prevent disease.

Have we as a profession been guilty of over=vaccinating our patients? Almost certainly we have. We have unwittingly given more vaccines to more patients more often than needed. We have done an amazing job of training our staffs and clients to view immunology like Cinderella's carriage, at midnight at the end of the twelfth month all immunity expires. Pets have been routinely revaccinated at 12-month intervals when few knowledgeable individuals doubt that immune memory provides far longer protection. Pets are too frequently vaccinated against diseases where the risk of infection is minimal, the severity of the disease is mild or the efficacy of the vaccine is questionable.

Economic staple?

We have come to treat vaccines as a commodity linked strongly to our very real desire to maintain regular patient and client contact. Have we done so for lack of concern for patients? Definitely not! We have done so because we believed that was in the pet's best interest. Simply using revaccination as a management tool is not acceptable. The profession must shift its emphasis away from dependence on vaccines as an economic center and develop new ways to provide care and service that will drive clients to seek medical services for their pets.

If what we have been doing has worked, why change? Why fix it if it isn't broke? Well it is broke! Increasingly, we have associated vaccines with adverse events. Increasingly we have learned that modern vaccines conferred immunity far superior to what we believed. Increasingly we have recognized that not all pets are at risk for all diseases. So the logical conclusion would be that we have ,in fact, vaccinated excessively. Additionally, we have come to rely on vaccination as a tool rather than a medical procedure. The suggestion of the guidelines is not as simple as to vaccinate less for the sake of vaccinating less but rather to vaccinate appropriately for the sake of the pet and the client.

It would be incorrect to assume that the AAHA guidelines are an association standard or a new protocol. The guidelines advocate for individualized vaccination schedules with attention to the relative risks and benefits to a patient. The guidelines do acknowledge and advocate for the fact that vaccinations provide a longer duration of immunity than has been generally accepted and provides a consensus opinion of a group of knowledgeable and involved individuals who have declared that no universal protocol is appropriate or acceptable.

The AAHA guidelines are not a protocol. They are a guideline, a suggestion with which one may agree or disagree. These guidelines and similar guidelines such as the AAFP guidelines for feline patients are experiencing increasing acceptance and implementation. Those who adopt these guidelines are in the company of many, if not most, recognized authorities in vaccinology and infectious diseases. It is not unlikely that in the future, those who maintain traditional vaccination protocols will be asked to justify that approach just as those of us who advocate for reduced frequency of revaccination are being asked to support that position. To continue to vaccinate indiscriminately does demonstrate a lack of awareness and a lack of concern for our patients. Such an approach will be harder and harder to defend.

On the other hand, to make an informed decision with knowledge and input from our clients even should one continue to revaccinate yearly is not an unreasonable decision. The key is informed decisions, not head-in-the-sand decisions. With time, the fog will lift and greater certainty will result. Until then, whatever you decide, you as the medical advisor must be prepared to support your recommendation and you must make an informed non-fear based decision to do what is best for your patient and your client.