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Old June 25th, 2007, 04:30 AM
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Dr Lee Dr Lee is offline
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Join Date: Jun 2007
Location: Bay Area California
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I thought I would throw in a veterinarians point of view...

When I became a hospital owner, the retiring vet told me that I would give up my minimalistic vaccine protocols and start vaccinating for as many things as i could. Actually now that I am an owner, who can set all of my hospitals protocols, my vaccine protocols HAVE changed (about every 6 months or so, i re-evaluate them due to the ongoing research and new information) and I am vaccinating even less than before! (he thought I was minimalistic then! he should see me now!)

Celtic Fox: I think you are well justified in being upset. Regardless of vaccine views - you did not ask for vaccines that were given after you had been explicit with what you wanted. I think you should inform your regular veterinarian. I know as a hospital director - I would want to know; however I hear better with calm discussion than with yelling

I would like to offer some explinations for perhaps this common vaccine view of veterinarians since this is such a hot topic and address some myths.

I can't explain why he/she gave the additional vaccines, but I think an attempt to deceive is unlikely. Unfortunately it may be that it wasn't seen as a big deal. But you are right; it is a big deal.

Why do vets give so many vaccines? In school we are told to, out of school the vaccine companies bombard us with reasons to use their vaccines, clients walk in for the service, we get so used to giving them that we worry less about the reactions than with many other medications, and because, and this is important, many lawyers urge us to. There is currently over a $30'000.00 law suit against a vet because his adult dog got leptospirosis and didn't get a leptospirosis vaccine (vet didn't forget to give it, it wasn't his policy - it is a controversial vaccine and many feel the risks outweighed the benefits and that the benefits may be minimal either way). Now I know many vets that didn't give it before, that now vaccinate every dog with it. Finally i think the most important reason that we give so many vaccines is that few other procedures in medicine (human or animal) have saved so many lives. I think of polio in humans and parvo in dogs as prime examples. Most every parvo dog I see is a young, never vaccinated puppy.

Should we be giving so many vaccines? No... and yes.

Why no?
As many of the members will tell you, there is increasing evidence that many vaccines last much longer than one year. Some studies at Texas A&M have shown pets to have good protection up to seven years. There is much evidence that they may last a life time after the initial puppy/kitten set. Furthermore there is reason to believe that older dogs, especially ill dogs, may not respond to the vaccines. Remember all the tests on vaccine response done to make a new vaccine are performed on healthy young dogs (usually beagles). So age, breed variation - not to mention any other health concerns, nutrition etc... are not taken into account. Then of course there are the pets that have serious, sometimes life threatening reactions to them.

So why don't all vets just give initial puppy sets and thats it? or go every 7 years? Well believe it or not, even with the many tests - the specialists are not in agreement. I know two AVMA presidents who give all vaccines other than rabies every year. Then you have Dr Dodds (mention above - a good source) who has a very differnent view. The reason for the controversy? While many people think it is monetary - the vets I associate with have many other concerns. Law suits are high on the list; Unfortunately - force of habit is common (This is the one that gets me upset). Most importantly (the number one reason for me) is we don't want to let down the pets. One of the problems is that much of the evidence with regard to vaccine length is due to titers. Titers are great - I recommend them often; however for study with vaccine, challenge tests are needed and the challenge tests which have been done are great starts but not to the thoroughness needed to sway many of the immunologists. Why haven't these tests been done? This is where the money comes in ---- the vaccine companies do not want this done. Heaven forbid we use less of their product. There isn't enough specialist agreement to make any standard recommendations that are accepted nation/worldwide. AAHA is the closest resource that has made an official stand (and many vets disagree here as well). Here is the site to dog AAHA protocols (you can go from there to cats): http://www.aahanet.org/About_aaha/Ab..._Canine06.html

So in a nutshell as time goes on and continued testing and information is revealed and more vets become progressive and god willing the lawyers let us help pets (if any of you are lawyers, please don't take this personally - I have three lawyers in my family who I love and are ethical, but the law suits have done both bad and good in health care) --- I think we will see less and less vaccines. At least in adult pets with the basic four in one....

So why did I mention that there may still be a lot of vaccinating. While there is much evidence that the distemper and parvo vaccine last a long time; there is considerable evidence that many vaccines against bacteria and toxins do NOT last very long. There is some new evidence that the leptospirosis vaccine may not last a complete year. I just attended a lecture that recommended four in one and rabies every 3 years and leptospirosis every 6 months if the pet was in a risk environment. (AAHA current protocols state yearly but the lecturer quoted this and stated there was evidence to the contrary - where do we make the decision? Who do we believe?)

So which vaccines does your pet need and how often? Leptospirosis? Giardia? FIV? Corona? Rattlesnake? Lyme? FIP? Now each of the vaccines I just mentioned have their own set of controversies - Lepto: is the vaccine working against the serovars that we see clinically? Is it worth the risk of reaction? Giardia? The vaccine doesn't stop infection but may lead to less shedding and signs? So is it worth it? FIV? Pets test false positive but only protect at 86% - so 14% may be actually infected if exposed and we wouldn't know. Corona? Generally no one likes it however if a puppy gets both parvo and corona infection together - death rates rise. And the list goes on....

Does it end here? Nope. Now there is different brands and qualities of vaccine. There are a couple of rabies vaccines that I would never use in a pet. Also there is recombinant vaccine technology out there. This is important for FeLV - this vaccine has been linked with causing a very deadly form of cancer. The recombinant vaccine (given by needless injection through military technology to deliver the vaccine in a jet of air and uses only a fourth of the amount that a regular vaccine would) has so far never been seen to cause cancer. Feline recombinant rabies also has the same claim although does not need the air injection device but a standard needle. Also recombinant is great for distemper, parvo vaccine - it causes less reactions and better response - currently it is the only vaccine that should be used on Weimaraner puppies EVER. It also doesn't cause immune suppression like some other vaccines do.

How many people have I lost so far??? Unfortunately I feel that this topic becomes so confusing that it can be just easier for some vets to give the vaccine to the pet and move on. This is a mistake though.

At my hospitals we have standard protocols for lifestyles as well as a waiver that starts out with the sentence, "Currently there is much controversy with regard to vaccines" and ends by asking them if they have questions. I firmly believe that some pets need annual vaccines to help guard their lives. I also firmly believe that some pets after their initial set of vaccines should never be vaccinated again. Do I sell clients more additional vaccines or sell them less than they were expecting when they walked through the door? Absolutely, I have more people we change their pets vaccine plan for LESS than expected.

Earlier in the thread there was a comment that it should be the clients choice of vaccines and not the doctors. Let me revise that a bit if I may. It should be the INFORMED client's choice. That is, I believe that our duty as veterinarians is to educate the clients about their options and what may be needed (or NOT needed) based upon their pet's lifestyle and health status. Once the client has been informed and feels comfortable - then the choice should be made. If the veterinarian is doing his/her job right - the pet will have only the vaccines that it needs for its health and life style and the client should feel happy and comfortable with the decision. My business has less than 10% revenue based on vaccines. When I give a vaccine, it is because to the best of my knowledge with the available data, it is the best for the pet. I feel that every time I don't sell a vaccine I make money - because I have something better than money in hand - I have client trust, their return to me when they need and often their referrals. The trust and the knowledge of doing what is right is worth more than money...


I am sorry if this is long winded and does not get anyone angry but I have seen this topic come up and I have these questions from my clients all the time so I thought it might be useful.
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Christopher A. Lee, D.V.M., C.V.L.S.
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