If You Give a Vet a Soapbox...My Response to the Anti-Vaccine Movement

Moments ago I finished -- with a dramatic flourish -- an e-mail response to a very good client whose insightful questions about his pets constantly keep me on my toes. What started as a quick note developed into a lengthy and impassioned epistle. I found myself so wound up by the time I hit "Send" that I couldn't help but expound my point of view to anyone who would listen. Dear reader, that may be you if you choose to continue.

Hey Dr. Kim,

Not sure if you saw the attached article or not. It was a good read I think, and thought you may find it interesting. All is well with Puppy. We will see you in a few weeks for another check up with him. Hope your weekend was well! 

Thanks,

Puppy Owner

Subject: puppy vaccinations

I found this link that may be of interest to you now that your puppies have just received their second shot. This is a very important read, for you to discuss with your vet.

The puppies will be ready for their rabies shot in a couple weeks but according to this article which has some very strong articles to support, there is no need for anything more than rabies this year.

Know that I gave the parvo/distemper shot to them at home at 7 1/2 weeks old. There were not exposed at the vet's office. This is the safest way/time to give a vax not knowing what all the puppies would be exposed to as they went to their new homes....

Kindest regards~
Puppy Breeders
http://www.dogsnaturallymagazine.com/five-things-your-vet-says-that-arent-true/

Dear Puppy Owner:

I'm glad you sent the article. I could read on this subject for hours, clicking links to this and that!

So much of the article is correct. As I read it, though, I felt myself waiting for the author to complete a train of scientific thought as I learned in immunology training [the study of the immune system]. And when they didn't I realized it must be because the omitted part would actually lessen the effectiveness of their argument. There are so many points in the article where I wanted to shout "But that's not the whole story! You forgot about individual variation or herd health medicine or maternal antibody variability or compliance or practicality, economics and human fallibility!" 

People mistakenly believe the practice of immunology in human and veterinary medicine is done in favor of the individual. Vaccination critics believe an individual's risk outweighs the public's benefit. But the cold hard truth is immunizations are not done solely for the best interest of the patient but for the public interest.

A dog is not vaccinated against rabies to protect him from dying of rabies (although he indeed benefits in this way). A dog is vaccinated against rabies to create a barrier of protection to the human population from rabid domestic animals. If animals who interact closely with the human population (such as dogs) cannot contract and pass the rabies virus, then fewer humans will die of rabies. That is the goal of rabies vaccination in pets. A corollary argument is that a dog vaccinated against parvovirus (or distemper, etc.) helps protect the whole population of dogs from parvovirus. Just as parents who refuse to vaccinate their children are relying on "herd immunity" (i.e., the fact that the U.S. population is well vaccinated against certain deadly illnesses) to protect their unvaccinated children, pet owners who do not vaccinate have relatively "protected" pets because the animals they interact with are vaccinated and cannot pass on disease.

I could write a dissertation in response to the arguments laid out in the article! But I do want to point out two things regarding the Breeder's e-mail and how it relates to Puppy:
1) Puppy Breeder's email says the pups were vaccinated against parvo/distemper at 7-1/2 weeks and do not need any further shots besides rabies. This statement does not even agree with the article much less current standard of practice. The article says a single vaccine at 12 weeks is sufficient, not one prior to 8 weeks of age. 
2) Dr. Ron Schultz's research is quoted extensively in the article in support of vaccinating only once at 12 weeks. Dr. Schultz was my immunology professor at UW School of Veterinary Medicine. [I am a 2007 DVM graduate.] We were taught to make sure the final "distemper" vaccine was given at or after 16 weeks (not 12). 

There are many scientifically proven reasons for boostering more than once in puppies. There are different types of immunity and boostering increases long term "memory" in the immune system. Also, maternal antibodies interfere with vaccination in puppies. That's why puppies (and babies) receive a series of vaccines. The reason we do not wait until 12-16 weeks is because we cannot be sure a) whether the mother was properly vaccinated and b) whether the puppy/baby received enough immunoglobulins through first milk colostrum (a bigger risk in large litters where pups fight for resources). 

Over-vaccination is a real concern, but I do believe in the societal and clinical benefits of vaccinating my pets as well as my children. Some vets (as indicated in the article) recommend annual vaccination for everything, but this method of practice is changing. Dr. Schultz taught us that many pets have more than 1 year (and even more than 3 years) of protection from vaccination, it's true. Many viral vaccines are FDA licensed for administration every 3 years. Until new research and licensing shows protection for a majority of animals beyond 3 years, most vets will vaccinate every 3 years for rabies and "distemper." Yes, you can have antibody levels tested for parvovirus or distemper virus and choose not to vaccinate if levels remain high. However, this is not commonly done because the serology test is not inexpensive. 

Some types of vaccines (for bacterial diseases such as Lyme, Leptospirosis and Bordetella) do NOT provide proven protection much beyond one year. In fact, Bordetella is sometimes given every 6 months to dogs at high risk for Kennel Cough because the body does not make the same long lasting immunological response to bacterial diseases as it does to viral disease. (This probably explains the recent Whooping Cough outbreaks in humans...Whooping Cough is related to Kennel Cough; both are caused by Bordetella organisms!!! As children we receive the "Pertussis" vaccine but lose protection over time and may become susceptible as teenagers or adults.) The canine vaccines I just mentioned are lifestyle vaccines. Not all dogs should or do receive them.

Whew. I'm exhausted. This is such an emotional topic from either side! I find it interesting that the same diseases "anti-vaccine people" claim stem from vaccination in this article are the same diseases "anti-grain pet food people" claim stem from commercial diets. It would be foolhardy of me to say any of these claims are complete nonsense! There is so much we do not fully understand of the intricate workings of the body and our environment. There are many truthful statements in the article. Good physicians, veterinarians, and scientists continually study and learn. Good doctors pay attention to what works and what doesn't, rely on a body of properly done objective studies (believe me, anyone can do a study to prove what they want to prove!), and think about the whole picture when it comes to health and disease management.

I would be happy to discuss the article, my comments and any additional questions you may have at Puppy's visit next week!

Dr. Kim 

Shortly after my earnest e-mail shot through cyberspace, my kind client responded with a mildly exasperated yet placating e-mail, soothing my raging frustration. I didn't have much convincing to do apparently. As long as such mental gymnastics don't give me a coronary, I'll just be grateful for the chance to debate interesting and important topics with other people who care. 

Thoughts on Vaccinating at Home

"I'm just here for a rabies shot. I give my dog the distemper vaccine at home myself." This sentiment has repeated so often lately it's become somewhat of a theme.

I grew up on a farm. We gave our farm dogs distemper vaccine at home. For this budding veterinarian, it was fun to play doctor. And it certainly was economical.  Now, as the Practical Pet Vet, I appreciate self-sufficiency and I understand the desire to save money. My goal as a preventative medicine practitioner is to help owners make the best decision for their animal's care from youth until old age. Today's blog is not meant to persuade you not to vaccinate at home. I hope to enlighten you, the reader, about aspects of vaccination you might not have considered.

Parvovirus is highly contagious and often deadly,
especially in young puppies.

I believe vaccination is an important part of preventative health care. Periodically there are outbreaks of canine distemper and parvovirus that trigger rumors of "new" deadly virus strains against which current vaccines are not protective. In actuality, across the U.S. there are pockets of unvaccinated and inadequately vaccinated dogs that are highly susceptible to these preventable diseases. A dog would be inadequately protected if it did not receive vaccine boosters according to schedule as a puppy and young adult. If you're going to vaccinate at home, PLEASE consult your veterinarian to make sure you've timed your puppy's distemper series properly.

An emerging sentiment among many clients is that pets are over-vaccinated. Based on recommendations from independent researchers on vaccine effectiveness, many veterinarians now vaccinate against rabies and distemper every three years. The canine 5- and 7-way vaccines I've seen for purchase at pet stores are labeled to be given every year. Most likely this over-the-counter vaccine is protective for longer than a year. However, because you can't be certain the vaccine was handled properly (meaning kept at the proper temperature during transport and on the loading dock) it may not be as effective as those carried by your veterinarian whose vaccine shipments are more precisely controlled. Boostering annually with the pet store distemper vaccine increases the odds your pet has received a potent dose at several points in time.

Facial swelling may be a
symptom of a vaccine reaction. 

Vaccines, like all medicines, provide many benefits to health but are not completely without risk. Most dogs and cats respond as expected to vaccination and enjoy the benefits of protection with just a moment of minor discomfort. A potential side effect of vaccination in some pets is vaccine reaction, the severity of which ranges from mild GI upset to moderate facial swelling to severe anaphylactic shock and death! I worry that owners who vaccinate at home do not anticipate a vaccine reaction in their pet. Imagine the horrific irony of vaccinating your dog at home on a Sunday night to save some money, then having to rush to an emergency clinic for treatment of a life threatening reaction. If you're going to vaccinate at home, try to do it when your veterinarian is available to help you in the event of complications.

In the end, if it comes down to choice between not vaccinating your dog at all or vaccinating at home I'm certainly in favor of home vaccination. As with any medical treatment there are risks and benefits to consider. I hope to have made some educated consumers today.

Happy Birthday, Kitty!

People always want to know how old their dog or cat is in human terms. The rule of thumb for dogs has been one dog year equals seven human years, but we know that it not exactly right. Little dogs like Bichons tend to live longer than big dogs like Newfoundlands. Also the first few years of a dog's life are accelerated. A one-year-old dog is capable of reproducing and so it is definitely not the equivalent of a seven-year-old human (unless you believe those crazy tabloids)!

Unlike dogs, after the first few formative years of life, the ratio of cat years to human is about 1:4. As you can see, a feline surpassing 20+ years is deserving of a Willard Scott-esque birthday celebration!

Cat's Age               Equivalent Human Years
 1 year                    15-18 years
 2 years                   21-24 years
 3 years                        28 years
 4 years                        32 years
 5 years                        36 years
 6 years                        40 years
 7 years                        44 years
 8 years                        48 years
 9 years                        52 years
10 years                       56 years
11 years                       60 years
12 years                       64 years
13 years                       68 years
14 years                       72 years
15 years                       76 years
16 years                       80 years
17 years                       84 years
18 years                       88 years
19 years                       92 years
20 years                       96 years
Adapted from Think Like a Cat: How to raise a well-adjusted cat -- not a sour puss by Pam Johnson-Bennett


Here are some tips for helping your kitty reach his or her "centennial" celebration.

1. Schedule annual wellness exams with your cat's veterinarian even though vaccines are not due. Most progressive veterinary clinics now booster feline vaccines only every three years. That's the equivalent of 12 years between doctor visits in human terms! Screening bloodwork should be performed periodically (and at least annually in senior cats) to catch certain diseases early. Early detection allows for easier management and a longer, happier life.
2. Spay or neuter your kitty to avoid medical and behavioral problems that may result in accidental death, illness or euthanasia.  
3. Feed your cat a high quality cat food but limit portions! Obesity is a huge problem in felines leading to diabetes, arthritis, heart disease, and skin problems from inability to groom. Most cats do not get enough moisture in their diets and suffer from GI and urinary problems as a result. Train your kitty early on to enjoy quality canned or moist foods. Dry food does not -- I repeat, does not -- prevent dental disease.
4. Dental disease is a common and painful condition in many cats, and it negatively affects their overall health. Ask your veterinarian for advice on how to prevent and manage dental disease in your cat. Just like people, most pets should have their teeth professionally cleaned (i.e., by their veterinarian) periodically.
5. Know what plants and household items are potentially toxic for your cat to avoid tragic illness or death. Also, PLEASE remember very few human medications are safe for cats. Some over-the-counter flea and tick treatments are OK for dogs but are deadly for cats!
6. Environmental enrichment can improve the quality and length of your cat's life. Many feline diseases are linked to stress. Learn as much as you can about feline behavior and play with your kitty every day. Especially in multi-cat households, make sure you have provided the proper resources for cats that may not get along all the time. A rule of thumb for litter boxes is "1 per cat plus 1." That means if you have three cats, you should have four litter boxes. Also properly placed scratching posts may eliminate the supposed need for declawing. By "properly placed" I mean in highly visible areas the cat has chosen, not the owner!  

Sadly, even with proper care and the best intentions some cats do not live to ripe old age. It is no different with us humans (I'm thinking of the fit and trim 30-somethings who die tragically from cancer or accidents). However, cats who receive proper exercise and nutrition, regular medical and dental care, and environmental enrichment will have an improved quality of life no matter how many candles are on their tuna cake.

Driving me batty

My husband hurried into the house the other night slightly breathless. He had been outside closing up one of the outbuildings when a bat breezed in and out of the shed inches above his head. The stuff of vampire lore and Hollywood hype, bats have been giving humans the heebie geebies for millenia. Unfortunately, in recent years bats have also been giving humans the deadly rabies virus.

Bats are actually wonderful creatures. A small bat can capture more than 1,200 mosquitoes in a single hour! They are also sensitive to environmental changes and may act as a "canary in a coal mine" for ecologists. Cave bats (the type that like to roost in attics) are currently threatened by a strange fungal disease called white-nose syndrome. In 2010 they were extended protection from extermination under Wisconsin law.

Despite their virtues, I get a little freaked out about bats. Last spring my newly remodeled old farmhouse was haunted by a bat for several weeks. It tended to show up in the family room while the television was on. Once, while I was tracking it through the house in an effort to shoo it outside, it made a pit stop in a ceiling light fixture. Crouching on the floor and wearing a winter stocking cap (yes, I looked ridiculous), I gazed up in horror as the tiny winged mammal peered over the edge of the shade at me! Its beady eyes, pointy ears and toothy muzzle are imprinted in my memory. Before I could gather my wits it was off again, fluttering finally into an unfinished bedroom amidst construction materials. This scenario repeated over several evenings before I managed to open the front door during one of its sweeps through the living room. Although I never actually saw it leave, that was the last night it appeared.

Later that same summer my sister-in-law was similarly bedeviled by a trespassing bat. On several occasions she found herself trapped under her bed covers miserably text messaging me about her intruder. Finally, her fearless feline Izzie trapped the bat in the bathroom and that was the end of our bat saga. Or nearly so. Because bat droppings were discovered on the bedside table, my sister-in-law's family doctor recommended rabies prophylaxis. This is the series of injections given to prevent the development of rabies in people exposed to potentially rabid animals. If we had kept and killed the bat, we could have sent it in to the Wisconsin Veterinary Diagnostic Laboratory for testing to determine if rabies prophylaxis was necessary. Better safe than sorry. (The CDC provides good guidelines for whom should receive rabies prophylaxis.)

The first case of a successful rabies prophylaxis was in 1885. Louis Pasteur injected a child with recently invented rabies vaccine soon after the boy was mauled by a rabid dog. Amazingly, the child survived! Once signs of rabies appear the disease is always fatal.*

Bats have only recently been cited as a reservoir for rabies virus. Until the late 1980s, dogs were a major source of rabies in the U.S. Widespread mandatory vaccination programs have significantly decreased dog rabidity. Most human cases of rabies exposure in the U.S. are now linked to wildlife such as skunks and bats. Worldwide, however, dogs are linked to nearly 55,000 human rabies deaths a year. Efforts like World Rabies Day are underway to vaccinate as many canines as possible to reduce the incidence of human rabies.

Cat catches bat

Rules regarding rabies vaccination of cats varies by municipality. Many people feel their indoor cats do not need rabies vaccination. However, because you never know when your home might be visited by a bat intruder, and because indoor kitties like Izzie are ever so helpful in containing potentially rabid bats in the home, I strongly recommend vaccinating all feline friends--indoors or out. Rabies vaccination in pets is safe and inexpensive while the disease and prophylaxis in humans is certainly not!


* The miraculous recovery of the Fond du Lac teenager afflicted with rabies in 2004 should not give us a false sense of security. The therapy used in her case, the Milwaukee Protocol, has been used successfully in only two other cases of human rabies.