Researcher creates tool to gauge vaccine needs

Denver-To help practitioners make sense of the profession's three sets of vaccine guidelines, a Purdue University researcher offers a means to tailor the sometimes confusing array of protocols for use in everyday practice.

Dr. Larry Glickman, creator of the Vaccinometer, says the tool is designed to aid in individualizing American Veterinary Medical Association (AVMA), American Animal Hospital Association and American Association of Feline Practitioners guidelines for patients. While the tool is only available for use with dogs, a feline version is in the works.

Dr. Larry Glickman

"The guidelines are good, but practitioners are asking, 'How do I use them?'" Glickman says to a crowd of listeners July 19 at the AVMA's annual convention in Denver. "Your job now as practitioners is to tailor these guidelines. But how can a busy practitioner do that for each dog?

"The Vaccinometer is a simple tool that uses recognized principles of vaccination and evidence-based medicine to determine the optimum immunization strategy for each patient."

How it works

Developed using point-based values of low, moderate and high, the Vaccinometer asks veterinarians to consider six criteria: evaluating a patient's perceived risk for disease based on location, severity of disease, vaccine efficacy and safety, potential zoonotic spread and potential spread to other dogs.

With low ranking one point, moderate ranking two and high ranking three points, the system requires the veterinarian to add the results for a total score. A vaccine can be viewed as unnecessary if the patient score ranks six to nine. A score of 10 to 13 would leave vaccination optional, and 14 or more would require inoculation (see Table 1).

The Vaccinometer

"This utilizes not only the veterinarian-perceived risks versus benefits but also owner preferences, like different value systems," Glickman says.

Advantages vs. disadvantages

The system is useful, Glickman says, because it breaks the complex question of whether to inoculate into simpler components, identifies controversies surrounding vaccinations and can be used as a tool for communication with colleagues, clients and staff.

Built into the Vaccinometer are measures for a disease's infectiousness, pathogenesis and virulence. But what practitioners can't always answer is a vaccine's efficacy, largely due to a lack of research.

"Efficacy is the hardest to score for some people," Glickman says. "We need more scientific information."

Critics might also consider the Vaccinometer too simplistic of an approach to vaccine protocols, fueled by probabilities instead of deterministic explanations emphasized in medical education, Glickman adds.

Recommendations

To accompany the Vaccinometer, Glickman recommends using serology in cases where a dog's immune status is questionable. While titer checks do not provide perfect information, the value of testing outweighs its shortfalls.

"The key is to try to gather all the knowledge you can," Glickman says. "It's tough. You may never have enough information, but no expert should dictate your decisions for you. You have to make them by yourself."