Rabies vaccination: Should veterinarians exempt or not?

Candy was a beloved 9-lb, 11-year-old poodle living in a typical suburban community. Her routine consisted of playing in a fenced-in backyard and sitting on the porch watching squirrels. She was a spoiled dog and her owner, Ms. Simons, was proud to be the spoiler.

Recently, Candy was at the veterinary clinic for her twice-yearly wellness exam. It was time for her vaccinations, and Ms. Simons expressed her usual concerns about Candy's post-vaccination behavior—the dog was often tired and "not herself" after they returned home from the veterinary clinic. Ms. Simons asked Dr. Hardy if he would exempt Candy from her vaccinations because of what she thought were adverse reactions.

Dr. Hardy advised Ms. Simons that his vaccine protocols were based on his patients' individual risk profiles. Candy had little exposure to other dogs, did not board in an out-of-home setting and was elderly. He agreed that he could omit certain routine vaccinations. Candy had received Bordetella and influenza vaccines in past years. The veterinarian felt that these were no longer necessary for her.

Ms. Simons also thought a rabies vaccination was unnecessary since the dog had no exposure to other animals and was a homebody. She remarked that this, coupled with Candy's advanced age, put the dog at higher risk of adverse reaction than was necessary. Dr. Hardy told Ms. Simons that state law required her dog to be vaccinated against rabies. But Ms. Simons said her research showed that a licensed veterinarian could exempt a pet at medical risk due to existing pathology.

Dr. Hardy was in a difficult position. On the one hand there was state law to be considered. On the other hand, Ms. Simons was a longstanding, diligent client. The dog was at low risk. And the state did allow a licensed veterinarian to exempt animals in special cases. Dr. Hardy agreed to the client's wishes with the stipulation that if Candy's risk profile changed, the client should contact him and he would administer the rabies vaccination. Ms. Simons agreed, and Dr. Hardy exempted the dog from the mandated vaccination.

Five months passed and Dr. Hardy received a call from Ms. Simons on a warm August evening. She and Candy had been sitting on her back patio when Candy barked at a raccoon. The raccoon dashed to the porch, scuffled with Candy for a few seconds and then ran away. Candy was startled and jumped into Ms. Simons' lap, scratching the client's left arm. Candy and Ms. Simons were fine; however, the client wanted instructions from Dr. Hardy.

Dr. Hardy told her that rabies victims were often innocent bystanders, minding their own business when a disoriented, infected animal attacked. This may or may not have been the case with Ms. Simons' dog, but now the situation involved a dog overdue for a rabies vaccination, a suspicious encounter with wildlife and an injured pet owner. Dr. Hardy told Ms. Simons to bring Candy in for an immediate rabies booster and asked her to visit her physician for her arm injury.

The physician advised Ms. Simons to undergo rabies prophylaxsis treatment due to the circumstances of her injury. In addition, Candy had to be quarantined according to state mandates related to unvaccinated dogs encountering wildlife and possibly receiving a bite wound during the incident.

Ms. Simons was upset but recovered nicely, and Candy eventually resumed her pre-quarantine routine. Dr. Hardy thought that in retrospect, exempting the dog from the rabies vaccination had been a mistake. However, given the situation, he thought he'd made a sound decision based on the facts.

Rosenberg's response

Beware of vaccination exemptions—they can come back to bite you. Old age and a sheltered environment are not adequate reasons to exempt an animal from a state-mandated rabies vaccination. These exemptions were created specifically for the immune-suppressed, the chronically ill and postsurgical patients.

Bottom line—Dr. Hardy was wrong. He should have told his client that he respected her desire to exempt Candy from a rabies vaccination, but the dog did not meet the necessary requirements for exemption. This message, delivered with compassion and reassurance, probably would have resulted in Ms. Simons granting permission to vaccinate and thus preventing the unfortunate chain of events.

Get in touch

How would you have handled this dilemma? We we would like to know. E-mail us at dvmnews@advanstar.com or post your thoughts at http://www.dvm360.com/community.

Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, N.J. He is a member of the New Jersey Board of Veterinary Medical Examiners.