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antibody levels (titer testing). Over 99%
of
our patients
hava
a lifetime
immunity
without revaccination. If necessary, we will boost the
immunity with
the
appropriate single vaccine. TI1is info:rma-tion and
references
are
illustrated in
my
book,
"The
New Holistic W iY for
Dogs
w.1d
Cats."
Hepatitis:
Th
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Soft, nonpainful
Oral/Dental
Normal dentition, no gingivitis, no masses or
lesions,
no discomfort
on
palpation, can
open and
close
mouth
easily.
Normal
systems:
General Appearance, Integumentary, Respiratory,
Genitourinary,
Eyes,
Ears, Neural System, Lymph Noqes, Mucous Membranes,
Other Abnormality; Pain
The abnormalities listed
all
appeared normal The normal systems is a covering
sta tement , but curiously notes "pain" with no explanation. The eyes, previously reported as
sclerotic, are now reported normal. There is no indication of recommendation for further lab
tests or radiology which, with the symptoms discussed on March 22 d, 2oll, would seem
appropriate. The ongoing digestive problem was "treated" with probiotics, bu t no reference to
other major concerns. With all the previous signs and Guardian's concerns, the normality
expressed
in
this consultation seems questionable.
No
diagnosis was indicated and
no
therapy.
March
29
1
h,
2011
Guardian
is
concerned
about
the ongoing lethargy,
but
recorded as "doing
well"-
a
confusing contradiction. Considering checking thyroid and radiology.
April 4th, 2011
Guardian reports leg weakness, stiffness, and lethargy.
April
5th, 2011
Pica:
abnormal appetite nd the consumption of inappropriate items
is
a common
finding with s tressed individuals. This is deariy an indication of a patient in considerable
distress.
April 6'h, 2011
Sasha's Blend is dispensed. This is an appropriate proprietary l?roduct for joint care, but
hardly therapeutic for Colombo who, at the March 26"', 2011 appointment, shows no signs of
arthritic problems: "no pain, swelling, or decreased r nge o motion.
April7",
2011
l"elephone Communication
Colombo not able to walk or see very we l-concerned about qiabetes.
April 8th, 2011
Telephone Communication . ,d
Colombo's eyesight is going fast. Discussed nuclear scleros1s- noted only on March
3 ,
2011, but not clarified as
to
degree. No indication
of whether
the retina was examined.
Guardian is concerned about diminished y sight; missing steps.
Aprilll'", 2011
Transfer records to Danforth Veterinary Clinic
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April12 ', 2011
Examination indicates panting, loss of vision, h o ~ s e s o i l i n g , appetite o ~ a y
Excessive
nd
inappropriate urination with good appetite, are indications of stress
(hyperadrenal activity). The panting and loss of vision are o v i o ~ s l y very dlst4'bing nd
debilitating signs.
April13' , 2011
Referral to Dr Gray
April29ri', 2011
lethargy, heavy drooling, blind
May
2nd,
2011
Retinal degeneration was reported (permanent blindness). No beneficial tre tment was
offered.
June
11 ', 2011
lethargic, anorexic, labored breathing.
June 13 , 2011
t
Veterinary Emergency Clinic, chest radiology showed indications of pnet1monia
June 14' , 2011
Dr
Alan Norris report and summary:
Dr.
Au,
I
believe
the clinical
signs
for
which Colombo was a d m i t t e ~ to
the
VEC
were
secondary to pneumonia and respiratory distress.
At
the time of presentation
Colombo was weak,
pyrexic, with increased
panting and
coughing. [n the hours following presentation he became
duller
and
his respiratory signs worsened; he
was started
on nasal oxygen therapy. His
oxygen
requirements were
high
5
Urn
in)
and
he
was
treated
with intravenous fluids, broad spectrum
antibiotic coverage (ampicillin, enrotloxacill), nebulization
and
coupage.
J,lis clinical s i ~ ; n s
improved
initially
but
worsened after 2
days in hospiial.
Initially bronchoalveolar lavage had
been
discussed to
help determine
the nature of Colombo's
pulmonary disease, but due to
increased anesthetic
risk (given
the
level of
respiratory
difficulty);
we eleated
not to pursue
this.
There
was
no prelvous history
of
vomiting/possible aspiration and the
u n d f ; ~ r l y i n g
cause of
Colombo's pneumonia remains
unknown.
Colombo displayed
weakness
in
all
limbs
and neurologic
deficits
in th< > pelvic limbs.
At
this time it
is
not clear
whether these changes were secondary to profound systemic disease, or
the result
of
a true
underlying neuropathy. Given
Colombo's severe
respiratory signs
our
neurolo ;ist,
Dr.
Kilburn, recommended that he be re-examined after resolution
oc
further
treatment of the pneumonia, and that an
MRI
ofthe spine be
perfonned
to
help determine the
etiology of Colombo's neurolo ,>ic
signs.
Given the
historical findings
of
polyuria, polydypsia
and
polyphagia,
aud
the
elevated
resting cortisol underlying
hyperadrenocorticism was suspected.
A
o o ~
connect
x s ~ s between
development
of sudden acquired retinal
degeneration
(SARDs) and h y p e r a d r e _ n o c o ~ I o . t s ~ . A_ low
dose
dexamethasone
suppression
test
was
initially recommended
after resolution of cbmcal
s1gns.
Due
to worsening of
clinical signs and financial
concerns, o w n ~ r s elected to h\lmanely
euthanize Colombo overnight
on June 14, 2011. We
are
sorry for
the loss
of
a
beloved
companion.
:ca
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My Summary
On March 3rd, 2011, Colombo was a generally healthy middle aged dog under some stress from
digestive abnormalities.
In
spite of
the
unwellness, he was inoculated with mult\ple vaccines without
consent. The need for
these
vaccines (other than Rabies)
is
in my opinion, negli(iible.
It
was clearly a
mistake
to
give any of those vaccines to an unwell dog.
Colombo continued
to
have some debilitating signs over the next few weeks. The examination
on March 26"', 2011, was poorly documented and definitely did not reflect the seriousness and concerns
of the Guardian. No diagnostics or therapeutics.
Over the next two weeks continuing decline in Colombo's health leading to total irreversible
blindness diagnosed as SARDs. This l
in
reaH:y not a diagnosis, but rather an ~ J x p r e s s i o n of the
unexplained severe degeneration of rs
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Summary
Vaccination Adverse Eve14ts
ROTH, J.A., "Mechanistic Bases for Adverse Vaccine Reactions
and
Vaccine Failures," Advances
in Veterinary
Medicine,
Vol. 41,
pp.
681-700
p.682
"This
article provides
an
overview of some of he reasons why vaccines occasionally produce adverse
reactions
p.684
1
"When
animals deve lop adverse clinical signs within a few days
to
weel\g after vaccination it is important
to determine whether those clinical signs
were
vaccine induced
or were
not due
to
vaccination and only
j
coincidentally occurred after the vaccine
was
administered.
p.686
Modified live vaccine organisms
haw
been attenuated to have reduced virulence ..However, the
attenuated vaccine strains
may
be capable ofproducing disease in immwosuppressed animals. Induction
of disease by vaccine organism has
occasionally
been reported when modified live virus (MLV) vaccines
have been administered
to
healthy animals However.
i t
has
occurred much more frequently when ML
V
vaccines are administered to unhealthvanimals ...
An
example of vaccine-induced disease re,-ulting
from
administration of vaccine to unhealthy animals is
the
induction
of
encephalitis
by MLV canine
distemper virus vaccine
in
dogs infected with canine
parvovirus (Krakowka
et
al., 1982).
Vr/Cv >fl p 687- ADVERSE VACClNE REACTIONS Dl..i E TO VACC Nb-INPUCED IMMUNE
SUPPRESSION
An
ML
V bovine viral diarrhea BVD) virus vaccine
has
been shown
to
suppress nutrophil function and
lymphocyte blastogenensis in cattle (Roth and Kaeberle, 1983). This coFi elates with the observation that
cattle tend to be somewhat more susceptible to bacterial pneumonia after administration ofMLV
BVD
vaccines, especially i he animals
are
stressed at the time of administration. Several connnercially
available canine vaccines have been shown to be capable of inducing lymphopenia and suppressing
blastogenesis of peripheral blood lymphocytes (Phillips et al.,1989; Mll&tro et al., 1986; Kesel and Neil,
1983).
p. 687- ADVERSE VACClNE
REACTIONS
DUE TO
EXCESSIVE :q.IDUCTION OF CYTOKlNE
RELEASE
Interlukin 1 (IL-l), IL-6, and a tomor necrosis factor a (TNF-a)
are
potrnt proinflannnatory cytokines
that are released by macrophages and other cells in response to infectioq, endotoxin and bacterial
components, and some vaccine adjuvants. These proinflannnatory cytokines can induce a wide range of
clinical signs. They may induce acute inflannnation
at
the local site ofproduction, they may also induce
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CARMICHAEL, L.E., Canine Viral Vaccines
at
a Turning
Point
A
~ r s o n a l
Perspective,
Veterinary Medicine, Vol, 41.
Pp.
289-307
p.291
3
It has been estimated that more than 50% of office visits to veterinarians are associated with vaccination.
Several vaccines for dogs (and cats) have been licensed that have poor or qu
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p.297
Efficacious modified-live
CPV
2 vaccines have
been
highly successful
in r ~ v n t i n g
parvovirus
infections
when
administered to seronegative pups, or to dogs with very
low
antibody titers. They
normally
engender
rapid and
enduring immunity,
and
it is probable
that
immunity persists for several
years.
p.304
The reality that all vaccines carry some risks is not fully perceived by
many
owners
and
veterinarians
..
There is a need for better appreciation of
the
risk of adverse ryactions (Duval
and
Giger,
1996).
MOORE, G.E., et
al,
A Space-time Cluster of
Adverse Events s s o c i a t ~ d with Canine Rabies
Vaccine,
Vaccine
23 (2005) 5557-5562
p. 5557
4
Clustering ofadverse events or disease can serve as
an
indicator
of
potenti'll association between adverse
event and
vaccine administration ..
p.5558
... ncreased risk was associated with ..surgically neutered [dogs]. Dogs repeiving multiple vaccines at
one
encounter
were also
at increased risk
ofVAEs
[vaccine-associated eveqts] .
Materials and Methods
The
electronic
medical
records
of
Banfield,
the Pet
Hospital,
were
searched
to
identifY all dogs that
received rabies vaccine alone
in
combination
with
bordatella vaccine, coronavirus vaccine, multivalent
distemper-adrenovirus-parainfluenza-parovirus-leptospirosis vaccine, giardia vaccine, or borrelia vaccine
between January
2002
and
December
2003.
p. 5559
Results
During
the
24-month study period, rabies vaccination (alone or
with
other concurrent vaccinations) was
given to 257,564 dogs; there were 1146 V
AEs
diagnosed (0.445%; 95% CI:0.420-0.471%).
GROGNET,
J.
G.,
Rethinking Traditional
Vaccination Protocol,
A "\iC
Gazette;
Dec. 2011; 127,
12.
p.30
As Dodds points out, the clinical signs associated with vaccine reactions are varied.
They
can begin with
fever, stiffuess, sore joints,
and
abdominal tenderness.
Both
liver
or
kidney damage can be a consequence ofvaccines.
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Neurological disorders, including encephalitis have been reported. A condition called post-vaccinal
polyneuropathy has been associated with the administration of vaccines containing distemper, parovirns,
and rabies, producing incoordination and weakness, as well as seizures.
p.31
Vaccinosis is a diagnosis of exclusion. A dog suffers from symptoms, yet nothing can
be
found on
testing
to
detennine
the
cause ..
Dodds suggests that MLV are so antigenic that they can overwhelm the immune system of
immunocompromised dogs, and even healthy ones.
To current vaccine practices
Measure antibody titers
Don't overvaccinate, and avoid unnecessary vaccines
Don't vaccinate sick dogs or those with fevers.
5
...
Dodds concurs that
you
should avoid vaccinating animals who are already protected.
Despite the evidence Dodds presents, some veterinarians still believe that vaccinations is harmless
and
not linked
to
adverse effects or serious illness. At the extreme opposite end, people adamantly against
vaccinstion fuel hysteria by providing misinformation on negative effects ofvllccines. Dodds suggests
that
neither
of
hese polarized views are helpful.
MIYAJI,
K
Large-scale Survey
o
Adverse Reactions to Canine non-rabies Combined Vaccines in
Japan, Veterinary Immunology and Immunopathology 145(2012) 447-452
p.447
"We
performed a large-scale survey
to
investigate vaccine-associated adverse events VAAEs), including
anaphylaxis,
in
Japan by distributing questionnaires on V AAEs
to
veterinary hospitals from April , 2006
through May 31, 2007. Valid responses were obtained for 57,300 vaccinated at 573
animal
hospitals; we obtained V AAEs information for last 100 vaccinated dogs
in
each veterinary hospital. We
fuund that
of
he 57,300,359 dogs showed V AAEs.
Of he
359 dogs, death was observed in 1,
anaphylaxis
in
41, dermatological signs
in
244, gastrointestinal signs in 160, and other signs in 106.
"No
vaccine . .is completely effective or without adverse reactions, and vaccine-associated adverse events
(V
AAEs) do occur, albeit infrequently, after vaccinations.
p.448
Practicing veterinarians diagnosed adverse reactions and classified them in o 5 groups according to
clinical signs: death, anaphylaxis, dermatological signs .. gastro-intestinal signs (vomiting and diarrhea),
and other signs (including hypodynamia and anorexia).
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/
J
Reaction to Adjuvants
Many inactivated vaccines contain adjuvants that potentiate the immune response by creating a depot
effect in the tissues to provide a prolonged antigenic stimulus and by activating macrophages (Roitt
1984)."
Systemic Reactions
"Systemic reactions can include fever, lethargy, anorexia, oedema, urticaria, vomiting, diarrhea, corneal
opacity, dyspnoea, excitement, collapse, convulsions and, on rare occasions death."
MEYER,
E,
K., Vaccine Associated Adverse Events,
Vaccine and
~ c c i n a t i o n s Volume 31,
Number
3,
May
2001, p. 493-514
p. 500
''Unlike human medicine, there is no regulation analogous to the
NCVIA
[National Childhood Vaccine
Injury Act]
that
mandates veterinary reporting
of
vaccine-associated adverse events.
As
regulations
currently exist, vaccine manufa.."tllrers are
not
required t report adverse event reports that they receive
from veterinarians and consumers. F nrthermore, vaccine manufacturers are not currently required to
routinely submit adverse reports to
the
USDA, although USDA personneijilay request adverse event
records for review during manuf-cClllrer site inspections."
p.501
ADVERSE EVR'TS ASSOCL"-TED WTIH VACCINATIONS
8
"Adverse events associated v.ith vac.cination have been well described and are categorized I various ways.
For
the purposes of this discussion, adverse events associated with vaccines are classified as systemic or
local reactions."
p. 502
Systemic Reactions
"Clinical signs such as anorexia, leihargy, fever, and soreness beginning a few hours after vaccination and
persisting fur 24
to
36 hours are reported in association with vaccination. The causes of hese nonspecific
reactions may include vaccine organism replication ofmodified live vaccines, exposure to endotoxins,
adjuvant toxicity, or immune system responsiveness. Most reactions are q rild but
in
some cases the
animals are so severely affected that supportive care may
be
required. Because vaccinations are designed
to
stimulate the immune response, these kinds
of
reactions are
to
be
expected and have been referred
to
as
'normal
toxicity' associated withvaccination.
In
a clinical study involving 2288 routinely vaccinated cats
and kittens, nonspecific systemic signs were reported at a rate
of
1.2%. TJVs study also showed that
reactions were more likely to occur >Vilen multiple vaccines were administji red and that cats older than 1
year
of
age
were
more likely to experience reactions than younger animals."
p.504
"Type l l hypersensitivity involves cel l destruction mediated by antibodies."
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-
I f
a vaccine contains normal cell antigens such as erythrocyte antigens, it may induce antierythrocyte
antibodies, which
can
lead to immune-mediated hemolytic anemia.
Type
i l l
hypersensitivity involves the formation
of
antigen-anttbody il:mpune complexes. This initiates a
number ofbiologic processes, ofwhich the most significant is the component cascade.
p.
505
AUTOIMMUNE DISEASE
There is some concern that vaccination may trigger autoimmune disease. n a controlled retrospective
clinical study, a temporal association was made between vaccine administration in dogs and the clinical
onset of immune-mediated anemia.
IMMUNOSUPPRESSION
One experimental study showed a decrease in lymphocyte numbers anlf response to mitogens in dogs
vaccinated concomitantly with Rockbom strain
of
canine distemper and adrenovirus-1
or
adrenovirus-2.
p.
506
VACCINE
VIRULENCE
Residual vimlence
of
modified-live vaccine can cause adverse events
4
vaccinated animals.
X Reactions occurring 7 to 21 days after vaccination in cats, characterized by fever, anorexia, and lethargy
and occasionally accompanied by joint, spinal, or generalized pain, have been associated with vaccines
containing modified live C. psitacci.
Immunocompromised dogs vaccinated with modified-live canine distemper vaccines have been reported
to develop post-vaccinal encephalititis.
p.510
Postrnarketing surveillance plays a vital role in identifying and monitoring potential risks associated with
vaccine administration
as well
as
1\ith
product efficacy.
The
depth
of
he surveillance system's database,
however, is dependent on active reporting by practicing veterinarians.
p.512
Although vaccination plays a vital role in maintaining animal health, iJlere are risks associated with this
medicinal procedure.
NAVC 2007 Conference, Orlando,
Florida,
Proceeding of
the NJ\
VC
North
American Veterinary
Conference
Jan.
13-27, 2007, Orlando, Flor ida, p. 573-575
p.573
'Predicting the unpredictable vaccine reactions'
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I
i
f
information that was unavailable for this study; thus, the variation VAAE rllfes among single-antigen
vaccine may not be solely attributable
to
the primary vaccine antigen. The nearly linear response
relationship between number ofvaccines simultaneously administered and the V AAE rate suggests that
vaccine components other than primary antigen may contribute
to
adverse eents.
Neutering appeared to increase risk
ofV
AAE
more than sex.
MACY, D.W., Are We Vaccinating Too Much?
JA
VMA, Vol. 27, No, 4, August
15th,
1995
The
incidence of anaphylaxis and other adverse reactions appear to
be n c r ~ a s i n g .
p.421
One disadvantage to over-vaccinate is the cost,' Dr. Schultz said. 'The client is paying for something
with no effect or i t h the potential of adverse reaction. I believe that d v e r s ~ effects are increasing,
because we are putting more and more components into these animals.
p.422
11
There is a real concern
that
vaccines may predispose susceptible individmds to immune-mediated
disease,' Dr. Schultz said.
'The
more antigens we administer, the higher the potential for hypersensitivity.
Type IV, cellular-mediated. All these types of hypersensitivities are natural parts of the immune response,
but
they cause a
cer.ain
amount of tissue damage. That damage may occur in the kidney, liver, or as was
the case with the adrenovirus Type 1, in the eye.
p.423
...we must evaluate the
ris lc
-benefit ratio ofevery vaccine. In the case canine parovirus, for instance, the
risk
of
death from disease
is e:-.:tremely
high compared with minimal
yet
unproven risk
of
immune
mediated disease from the
a c c i n e ~
The more components we combine into a single dose ofvaccine, the more likely they are to interfere \/
with each other,' Dr. Schultz said. 'Wnen multiple vaccines are given, there is competition at the n t i g e ~
presenting cell level. That
i l l
prevenr the animal from responding normally to each antigen.
p.425
Experts urge balancing
risks
and benefits, and tailoring vaccination schedules to the individual patient.
'We should
not
allow politics, tradition, or greed to enter the decision,' Dr. Macy said. 'Changing
vaccination protocols does not need
to
mean less profit...Veterinarians and tp.e industry need to be honest
with ourselves and assess risk, and
not
be trapped in tradition.
HORZINEK, M.C., ''Vaccine Use and Disease Prevalence in Dogs and ;::ats,
Veterinary
Microbiology, 117 (2006) 2-8
Why
has veterinary medicine adopted a practice that causes raised eyebrows in the biomedical
enviromnent, e.g., when talking to immunologists? The reason is largely i s ~ o r i c : in the first years of
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..
C--- -------
----=------- -' --
vaccine development, the objective of maximum protection
was
thought
to
be achieved
by
maximum
antigenic stimulation."
p.4
The
scientific arguments in favour
ofless
frequent revaccinations are traditionally based
on
antibody
titers. Protection against most viral diseases is indeed antibody-mediated, and antibodies are easily
mediated.
n dogs these have been found to persist for more than 7years, the study did not look later."
12
"Finally, duration of immunity (DOI) experiments in dogs have
now
proven beyond a reasonable doubt
that 3 years protection is achieved against challenge with distemper, adrenovirus-1 and parovirus (Gore et
a ., 2005)."
p. 5
A year ly vaccination interview, sensibly part of a yearly health check, but not necessarily followed by an
injection, should become standard."
p.
"Whereas the 'one siz 'fits all shot has been practiced as a routine in the past, 'vaccination to measure'
will
have to come in its place in
the
future."
OBJECTIVE ASSESSMEN1
OF
JMMUNISATION
"Post-vaccinal serology
..
s
not
new
to
companion animal medicine: evidejlce of antibodies to rabies
virus decides whether a dog
may travel. _A fl assessment of he animal's immune status would provide the
vet with information about
the
success rate of
her
measures, and reassure tl .e client."
p. 7
"Interpretation
of
he serology datav.ill be an element of he vaccinal interyiew."
Most animals in an
area,
a prodnce, a country should
be vaccinated-
rather
than
revaccinating the same
dog
or
cat time and time again, which neither improves its own immune Stl\tuS
nor
contributes to herd
immunity.
HORZINEK. M.C., ''Vaccination Protocols for Companion
Animals:
The Veterinarian's
Perspective,"
J.
Comp. Path. 2010.
VoL
142.8129-8132.
p.l29
"Although geriatric medicine for
these
species has received some recent attention; there is little study
of
the
vaccination requirements
of
such n i m a l s ~
Ageing populations
of
companion dogs, cats and horses are animals that require specific veterinary
attention when it comes it comes to the prevention of infectious diseases."
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13
p. 130
Non-core vaccines are defined according to geography and risk of exposure
..
The recent surge in pet vaccination guideline groups
was
initiated
in
2000 .. and followed in 2003 by the
American Animals Hospita l Association (AAHA) for the dog (Paul et al, 2()06).
Guidelines result from a consensus process, are non-compulsory and are based on available, qualified
evidence; they are intended to complement the official information found
in
the package insert and should
fill in the gap between regulations.
Acceptance
of
his change has been slow, both by manufacturers and veterinarians, mainly because of
the misconception that the availability
of
vaccines with an extended duratiqn
of
immunity (DO ) would
mean that fewer vaccines would be sold and applied.
A
clinical examination is a standard
part of the
visit: only healthy pets are vaccinated, unless there are
reasons (e.g. chronic conditions
in
elderly animals) to
do
otherwise.
.l31
In fact the new adage is to vaccinate more animals with core components, but the individtL l.) dog and cat
less frequently (Day et al., 2007).
There are scientific and societal reasons for the change in immunization protocols. Scientific arguments
include the long persistence of protective antibody titers (in
dogs>
7 years for CDV and CPV; in cats> 4
years for FPV, FCV and FHV), the longevity
of
memory
B-
and T -cel l populations (life-long for some
antigens),
but
also by industry
in
preparation
of
heir product registration (which only establishes a
minimum DOl).
...
an
elderly
dog
needs a vaccination protocol different from that
ofan
adplescent (immunology).
The vaccination topics to
be
covered
in the
first
year may
serve as
an
example: the owner is informed
about preventable diseases,
the
advantages
of
vaccination versus treatment (risk-benefit considerations
including cost), potent ial side-effects
and
complications, a possible lack ofprotection
..
ad onset of
duration
of
protection.
p.132
There are also age-related diseases in the dog and cat: a higher stLSceptibility for infections and immune
senescence have been inferred and demonstrated.
Old dogs show lower lymphocyte proliferative responses and lower CD4:CD8 T-cell ratios, but have
protective titres against CDV, CPV and rabies before revaccination.
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15
vaccinated with the vaccine in question in a given time period is unknown, it is not possible to calculate a
troe adverse reaction incidence or risk rate."
p.705
Most surveillance efforts are designed to relate specific adverse reactions
to
recently administered
vaccines, that is, to vaccination in the previous hours, days, or even months. However, in the past few
years, there appears to be considerable increase
in
the number of dogs and
catS
recognized
to
have
immune-mediated diseases with onset
of
middle or older ages. While a variety qf causes or predisposing
factors are known
or
thought
to
precipitate immune-mediated diseases,
it
has been suggested that some of
these can be triggered
by
frequent e:>..-posure
to
modified live vaccines (Dodds, 1985)."
p.706
The present system of post-marketing surveillance for veterinary vaccines can be improved considerably
if industry-wide standards are adopted for characterizing and counting adverse reactions and if individual
manufacturers consider the following:
p.707
"Increase ascertainment of adverse reactions by encouraging more complete reporting by veterinarians."
"Vaccine manufacrlh-ers should standardize their reporting systems to be consistent with each other in
terms
of
type and severity
of
adverse reactions."
p.709
A decision
to
vaccinate companion animals against a particular disease may involve consideration of the
efficacy of
he
vaccine, me likelihood of the animal being exposed
to the i s < ~ a S e c a u s i n g
agent, the age
and health of he animal,
and
the probability of side effect."
DODDS,
W.J., More Bumps of the
Vaccine
Road, Advances
n
Veterinary Medicine, Vol. 41
p. 715
In veterinary medicine, evidence implicating vaccines in triggering immune-mediated and other chronic
disorders (vaccinosis) is gmwing (Dodds, 1983, 1993, 1995a, 1997; Phillips and Schultz, 1992; Alderink
et
al, 1995; Schultz, 1995a,b; DL-oval
and
Giger, 1996)."
p. 716
"Determining causality for adverse effectS of vaccines can be asked as three f .Uestions: Can it? (potential
causality);
Did
it? (retrodictive causality); and Will it? (predictive causality) (Stratton et al., 1994)."
Other factors to be weighed in considering the implications
of
causality include ..vaccine related issues
such as dosage in relation to body mass and age, advantages and disadvantages of modified live
(attenuated) and killed (inactivated) vaccines, hormonal state during vaccine (Smith eta ., 1990), and
periodicity ofbooster vaccinations in relation to duration of immunity (Dod9s, 1997). Alternatives
to
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16
current vaccine practices include measuring serum antibody titres; avoidance of unnecessary vaccines or
overvaccinating; caution in vaccinating sick, very old, debilitated, or febrile individuals."
OVERVIEW OF ADVERSE EFFECTS OF VACCINES
"The onset of adverse effects ofvaccinations can be expressed as au immediate hypersensitivity or
anaphylactic reaction; an acute event occurring 24-72 hours afterwards, or 10-28 days later
in
a delayed
type immunologic response (Dodds, 1983, 1995a, 1997; Tizard, 1990; Phillips and Schultz, 1992; Duval
and
Giger, 1996)."
"The
increasing antigenic load presented to the individual host by modified live virus (MLV) vaccines
during the
period ofviremia is presumed to
be
responsible for immunologic challenge that can result in a
delayed hypersensitivity reaction (Tizard, 1990; Phillips and Schultz, 1992),"
"These adverse vaccine reactions typically include fever, stiffness, sore joints and abdominal tenderness,
susceptibility to infections, neurologic disorders and encephalitis, collapse 'Yith auto agglutinated red
blood
cells
and
icterus ( amoimmune hemolytic anemia, AlliA).
"Liver enzymes may be markedly elevated,
aud
liver
or
kidney failure may occur
..
"
"Post-vaccinal polyneuropathy is a recognized entity associated occasionally with the use
of
distemper,
parovirus, rabies, and pre5llli1ably other vaccines (Tizard, 1990; Phillips and Schultz, 1992; Dodds, 1993;
Collins, 1994; Gloyd, 1995)."
"This can resuh in various clinical signs including muscular atrophy, inhibition or interruption
of
neuronal control
of
tissue and organ function, muscular excitation, incoordination and weakness, as well
as seizures (Dodds, 1993, 1997)."
p. 718
"Giving
annual boosters when
they
are not necessary has the client paying for a service that is likely to be
of little benefit
to
the
pef
s existing level ofprotection against these infectioj s diseases.
It
also increases
the
risk
of
adverse reactions from repeated exposure
to
foreign substances (Smith, 1995; Alderink eta ;
1995)."
p 719
"Polyvalent MLV vaccines that multiply in the host elicit a stronger
n t i g e ~ c
challimge to the animal and
should mount a more effective and sustained immune response .. However this can overwhelm the
immunocompromised
or
even healthy hos t that has ongoing exposure
to
other enviromnental stimuli as
well as
a genetic predisposit ion
that
promotes adverse response
to
viral challenge."
p 727
"An increasing number
of
experts
...
advocate lengthening the interval between boosters, especially for
geriatric animals (Frick and Brooks, 1981; Tizard, 1990; Alderink eta ; 1995; Schultz, 1995a,b)."
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17
Except where vaccination is required by law, animals that previously e x p ~ r i e n c e d an adverse reaction
to
vaccination or are at genetic or physiological 1isk for such reactions can have serum antibody titres
measured annually instead of revaccination."
p. 728
The overall risk-benefit ratio of usin2: multiple ant igen vaccines
:iven
sin:)j ltaneously and repeatedly
should
be
reexamined
..
"
DOl- Duration of Immunity
SCHULTZ, R.D., Duration of Immunity
for
Canine and Feline Vaccines: A Review, Veterinary
Microbiology,
117
(2006) 75-79
p.
76
The results
of
this
study
showed
that
antibody titres were maintained for years without revaccination.
It
also showed
that
all challenged animals were protected from clinical
i s e a s ~ J .
The results from
this
limited group
of
dogs clearly demonstrated the
Norden
modified live vaccines
provided immunity for
a t
lea,"t years against CDV and CPV-2."
" ...approximately
iOOO
dogs have been vaccinated with products from all tjle major US veterinary
biological companies. The DOI for the various products is determined by antibody titres .. "
p. 77
At present it should be understood that the rabies vaccines are the only products for which
the USDA
require minimum DOI studies
for
licensing purposes. Currently
USDA
approval is
not
required for the
recommendation of ell.'tended DOI vaccination programs for any other vaccine."
"Duration
of immunity
following vaccination or natural infection
is
dependent
on
two major mechanisms:
1) the persistence of
memory
B
and
T cells stimulated
at
the time
of
vaccination/infectionand (2) the
persistence
of
long
lived
plasma cells that I have termed "memory effector B cells", which continue
to
produce antibody
for years
after initial immune stimulation."
" ...
DOI
studies in both the cat
and
the dog show memory effector B cells" continue to produce antibody
to core vaccines in
the
absence of overt antigenic stimulation for many years. Thus, revaccination does
not appear necessary
to
maintain these cells."
SCHULTZ,
R.D
et al;
Age
and
Long-term Protective
Immunity in
Dogs
and
Cats,
J.
Comp.
Path.
2010, Vol.142, S103-S108
p. 103
"Vaccination can provide an immune response that is similar in duration to that following a natural
infection. n
general, adoptive immunity to viruses develops earliest and
is
highly effective. Such anti
viral immune responses often result
in
the development
of
sterile immunity and the duration
of
immunity
(DOI) is often l ifelong."
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18
The present study examines the DOI for core viral vaccines in dogs that had not been revaccinated for as
long
as 9 years. These animals had serum antibody to canine distemper vjrus (CDV), canine parolvirus
type 2 (CPV-2) and canine adrenovirns type- (CAV-1) at levels considered protective and when
challenged with these viruses, the dogs resisted infection and/or disease."
The
decline
of
immunity in older animals (immunosenescence)
may
make them more susceptible to
certain infectious diseases. Studies immunosenescence in the dog and cat have suggested a decline in the
immune system with age .. "
p.105
The
longest period
oftime
after initial vaccination that dogs were
sampl
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20
DODDS W.J., ''Vaccination Protocols for Dogs Predisposed to Vaccine Rfllctions, Journal of the
American Animal Hospital Association, May/June 2001, Vol.
37
p. 2
"There is increasing evidence in veterinary medicine that vaccines can tr igger immune-mediated and
other chronic disorders (i.e., vaccinosis), especially in certain apparently predisposed breeds."
"
...
vaccination does carry
with
it attendant risks."
ADVERSE EFFECTS OF VACCINES
As the most immediate recognized adverse effect ofvaccination is an immediate hypersensitivity or
anaphylactic reaction, practitioners are less familiar with the more rare but eq 1llllY serious acute or
chronic immune mediated syndromes than can occur."
Beyond the immediate hypersensitivity reactions, other than acute events tend to occur 24 to 72 hours
afterwards,
or
even 7
to
45 days later in a delayed-type immunological response."
The increasing antigenic load presented to the host individual by modified live virus (MLV) vaccines is
presumed
to
be responsible for the immunological challenge that can result in a delayed hypersensitivity
reaction.
The
clinical signs of nonanaphylactic vaccine reactions typically include
fev
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21
Among the more commonly recognized predisposed breeds were the Akita, American cocker spaniel,
German shepherd dog, golden retriever, Irish setter, Great Dane, Kerry blue terrier, and all dachshund and
poodle varieties.
A
significant portion of hese animals had been vaccinated with monovalent or polyvalent vaccines
within
the
30
to
45 day period prior to
the
onset
of
heir autoinunune disease.
SCHULTZ,
R.D., I
Considerations in
Designing Effective
and
Safe Vaccination
Programs
for
Dogs, Recent
Advances in Canine
Infectious Disease,
CARMICHAEL,
I,.E., (E.d.)
Although a few of he vaccines are available as monovalent products (e.g., rapies, canioe parovirus),
most
are available only
as
multi-component products that contain between 2 tolO components.
Core vaccines which are considered essential, and should
be
given to every dog, are termed are termed
core vaccioes. All other vaccioes are regarded as non-core and should be used io dogs considered high
risk on an as needed basis.
Diseases that pose serious risk to susceptible dogs, or to public health, which are readily preventable by
current vaccines ioclude rabies virus
(RV);
canine parovirus caused by canioe parovirus-2 (CPV
2);
canioe distemper caused by canine distemper virus (CDV); and infectious canine hepeatitis caused by
(ICH) caused by canine adrenovirus
type-1
(CAV
-1)
...controlled by adenoviflls-2 vaccioe (CAV-2).
Table2
Canine Distemper 7yr
Minimum
duration of nunuuity
Canine parovirus 2
Canioe adrenovirus-2
''Why are there significant differences io the number of doses and o m p o n e n ~ of vaccioes routinely given
io the maximum vs. minimum disease prevention programs? Those differences arise primarily from
misperceptions about how vaccioes work, which vaccioes are necessary, and how often vaccioe should be
given duriog the life of he dog to provide protective inununity.
If a dog is at high risk of exposure to an important disease like CPV-2, a monovalent CPV-2 vaccine is
recommended, not a multi-component product. The risk ofadverse reactions has been greater with multi
component vaccioes.
Canine parainfluenza
and B bronchiseptica-
CPI
is
included
as
a componeqt of all current parenteral
vaccines containiog CDV, CPV-2 and CAV; therefore
it
is
given
to
very
dog that receives the core
vaccine.
ADVERSE REACTIONS
The risks ofadverse reactions from vaccioes are not
well
studied,
nor
are adverse reaction rates well
documented.
Even
where documented, the information is not readily available. The inunuue mediated
hypersensitivities caused by vaccioes are well known and occur io every species.
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22
V ..
he most common vaccine reactions observed in dogs include pain, sqreness, stiffuess and /or lethargy
at variable times
of
vaccination. Swelling, persistent lump
.. Post-vaccin -1
neurologic disease (e.g.,
encephalitis) was rare
...
More recently it has been shown experimentally that dogs develop an
autoimmune response after vaccination, something that was known to ocpur in other species."
/ "Furthermore, a study
of
dogs in veterinary clinics showed a slight
n r e ~ e
in cases
of
autoimmune
V
hemolytic anemia within 30 days following vaccination with multi-comppnent vaccines."
WSAV A- Guidelines for the Vaccination ofDogs and Cats
Compiled by the
vaccination Guideline
Group
M J Day- Chairman,
School
of Veterinary
Science, University
of
Bristol,
UK
M.C. Horzinek-
(Formerly)
Department of Microbiology, Virology :Pivision, University ofUtrecht,
Netherlands
R.D. Schultz,
Department
ofPathobiological Sciences, University
of
wiscons in-Madison, USA
p. 1
We should
aim
to vaccinate everv animal with core vaccines, and to vaPfinate each individual less
frequentlv bv onlv civing non-core vaccines that are necessary for that animaL"
"The VGG has defined non-core vaccines as those that are required by only those animals whose
geographical location, local environment
or
lifestyle places them
at
risk
of
contracting specific
infections."
"Each country that had its own vaccination guidelines was also
asked to
send a copy
of
hese
to
the
VGG."
"Responses were received from 27 countries, both from developed and d iveloping nations."
The
VGG recognizes
the
importance
of
adverse reaction reporting schemes but understands that these
are variably developed in different countries. Wherever possible, veterinapans should
be
actively
encouraged
to
report all possible adverse events
to
the manufacturer and/qr regulatory authority to expand
the
knowledge base
that
drives improvement
of
vaccine safety."
p.4
A second major concept regarding vaccination
of
dogs and cats has been the recognition that we should
aim to reduce the 'vaccine load' on individual animals in order to n m ~ potential for adverse reactions
to
vaccine products."
p. 5
"Dogs that have responded
to
vaccination with MLV core vaccines maintllin a solid immunity
(immunological memory) for many years in the absence
of
any repeat vac\)ination."
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p.6
Antibody tests are useful for monitoring immunity to CDV, CPV 2, CAV 1 and rabies virus.
, Adverse Events
23
.
\
Adverse events are defmed
as
any side effects or unintended consequences (including lack
of
protection)
associated with
the
administration
of
vaccine products. They include any injury, toxicity, or
hypersensitivity reaction associated
with
vaccination, whether or
not
the event
can
be directly attributed
to
the
vaccine.
CPV-2 PAROVIRUS
p l8
DOl
after natural infection/disease is life-long
DOl after vaccination with
ML
V vaccine is
9
years or longer, based on challenge and serological studies
In geographical areas or isolation facilities where CPV-2
is
not endemic in domestic or wild susceptible
species, MLV vaccines should not be used as the virus will be shed and could potentially revert to
virulence a well as infect other individuals or other species
CDV- DISTEMPER
p.20
DOl after vaccination is 9 years or longer
p.
19
CAV-2
ADRENOVIRUS
.
...
here are combination or monovalent products to protect against the canine respiratory disease
complex (CRDC), which includes multiple bacteria (notably bordatella bronchiseptica)
...
SARDS
MONTGOMERY,
K W, et al, Acute blindness in
dogs:
Sudden acquired
retinal
degeneration
syndrome
versus neurological disease (140 cases, 2000-2006), Veterinary Ophthalmology, 2008, 11,
5,314-320
p.314
Objective to evaluate dogs with amaurosis and compare signalment history, 9ptbalmic examination and
neurological abnormalities between dogs diagnosed with sudden acquired retinal degeneration syndrome
(SARDS) versus neurological disease (ND).
Results 120 dogs were diagnosed with SARDS and 20 dogs with ND based on
ERG
results. Mixed-breed
dogs were most commonly diagnosed with SARDS as well as ND.
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"Cushings-like symptoms were reported more frequently in SARDS dogs ..."
p
315
"Besides exhibiting sings ofhyperadrenocorticism that can persist for months possibly due to chronic
stress SARDS dogs are generally considered systemically healthy."
"Neurological deficits reported in SARDS dogs included unilateral pelvic llipb weakness, decreased
conscious proprioception, and bilateral facial nerve paralysis."
p. 317
"Consistent
with
previous reports, dogs affected by SARDS were predomina1}tly middle-aged or older,
and females were more commonly diagnosed."
p.318
24
"
...
weight gain
and
lethargy that were commonly reported are probably relatl(d to the Cushing's like signs
that SARDS dogs exhibit."
"Polyuria, polydipsia, and polyphagia were reported more frequently (P
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