In light of the recently released American Animal Hospital Association (AAHA) Canine Vaccination Guidelines, many questions
have arisen among veterinarians and the public in general. Have veterinarians been over-vaccinating and are veterinarians
who do not adopt the guidelines guilty of over-vaccinating? The AAHA guidelines were conceived and adopted neither to prescribe
a particular protocol nor to establish one protocol as superior to another. The traditional vaccination schedules that veterinarians
have been working with and applying in their practices for years are based on years of tradition, a lack of pressing need
for change and a widely held perception that the protocols had been based on something once thought of as concrete. In other
words, we were working from a narrow perspective based on incomplete information and misunderstanding. The AAHA guidelines
as well as the American Association of Feline Practitioners (AAFP) guidelines were developed to provide veterinarians with
information to help them adopt the approach that in fact there is no one protocol but rather each individual animal should
be vaccinated with consideration of only medical concerns. What is best for each patient?
Need for change
As stated in the AAHA executive summary of the document, the guidelines are based on a combination of expert opinion, clinical
experience and published and unpublished support. It is unfortunate, indeed, that there is a paucity of scientifically reviewed
published data sufficient to make the guidelines irrefutable. Much of the data considered and many of the observations interpreted
in developing the AAHA Guidelines have yet to be published. It is important, however, to recognize that historically applied
protocols are largely based on tradition and empirical information. They were initially arbitrary and became traditional.
Even today, while there are definite changes in licensing procedures and labeling guidelines being initiated, minimum duration
of immunity studies have not been widely applied and maximum duration of immunity studies have not been done nor will they
likely ever be performed. The result is that annual revaccination became the norm based primarily on inertia -- a lack of
impetus or reason to change.
In human medicine revaccination recommendations are not based on duration of immunity studies or disease challenges. Human
recommendations are based on population studies and surveillance systems. Such studies and systems do not exist in veterinary
medicine today. However, there is no evidence to indicate that the immune system of a dog and cat responds any differently
than the immune systems of their owners. When were you last revaccinated against an infectious disease or a childhood illness?
The immune system is capable of an immune memory response well after humeral immunity has waned. The goal in vaccinating an
individual is not to prevent infection so much as to prevent disease.
Have we as a profession been guilty of over=vaccinating our patients? Almost certainly we have. We have unwittingly given
more vaccines to more patients more often than needed. We have done an amazing job of training our staffs and clients to view
immunology like Cinderella's carriage, at midnight at the end of the twelfth month all immunity expires. Pets have been routinely
revaccinated at 12-month intervals when few knowledgeable individuals doubt that immune memory provides far longer protection.
Pets are too frequently vaccinated against diseases where the risk of infection is minimal, the severity of the disease is
mild or the efficacy of the vaccine is questionable.
We have come to treat vaccines as a commodity linked strongly to our very real desire to maintain regular patient and client
contact. Have we done so for lack of concern for patients? Definitely not! We have done so because we believed that was in
the pet's best interest. Simply using revaccination as a management tool is not acceptable. The profession must shift its
emphasis away from dependence on vaccines as an economic center and develop new ways to provide care and service that will
drive clients to seek medical services for their pets.
If what we have been doing has worked, why change? Why fix it if it isn't broke? Well it is broke! Increasingly, we have associated
vaccines with adverse events. Increasingly we have learned that modern vaccines conferred immunity far superior to what we
believed. Increasingly we have recognized that not all pets are at risk for all diseases. So the logical conclusion would
be that we have ,in fact, vaccinated excessively. Additionally, we have come to rely on vaccination as a tool rather than
a medical procedure. The suggestion of the guidelines is not as simple as to vaccinate less for the sake of vaccinating less
but rather to vaccinate appropriately for the sake of the pet and the client.
It would be incorrect to assume that the AAHA guidelines are an association standard or a new protocol. The guidelines advocate
for individualized vaccination schedules with attention to the relative risks and benefits to a patient. The guidelines do
acknowledge and advocate for the fact that vaccinations provide a longer duration of immunity than has been generally accepted
and provides a consensus opinion of a group of knowledgeable and involved individuals who have declared that no universal
protocol is appropriate or acceptable.