Table 1: CORE canine vaccines, suggested booster interval and estimated duration of immunity.
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In the March/April issue of the Journal of the American Animal Hospital Association (AAHA), an Executive Summary of the 2003
Canine Vaccine Guidelines was published. A full text of the guidelines, recommendations, and supporting literature is available
to AAHA members on the organization's Web site (www.aahanet.org). The 2003 Canine Vaccine Guidelines represent the most comprehensive,
current review of canine vaccines published in more than 14 years . . . . it's very much worth a look.
The Task Force that authored the 2003 Canine Vaccine Guidelines have made a comprehensive effort to review each type (not
individual vaccine products) of licensed canine vaccine in the United States. Taking into consideration such factors as age,
consequences of infection, and duration of immunity of individual vaccine types, an extended table summarizes recommendations
for selecting and administering canine vaccines. What the task force did not do was to make specific recommendations on how
to implement the canine vaccine guidelines. That task, quite clearly, has been left to the individual practitioner.
Implementing the AAHA guidelines, it would appear, is a somewhat more arduous task made somewhat more difficult by the fact
the task force has recommended triennial booster vaccination for some (not all) vaccines. Here's the problem: For years, veterinarians
have endorsed and recommended annual vaccinations which, when appropriately linked to annual health care examinations, provide
a standard of care the profession strives to maintain. Under the recommendations put forth by the AAHA Task Force, how is
it possible to implement triennial vaccination in practice when annualized health care is the objective?
What follows is a practical primer on health risk profiles and how such assessments can be used to implement your own guidelines
using the 2003 Canine Vaccine Guidelines as a starting point.
Table 2: NON-CORE canine vaccines, booster interval, and estimated duration of immunity.
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Understanding terminology For those who have actually reviewed both the 2003 Canine Vaccine Guidelines, and the 2000 Feline Vaccination Guidelines,
it will be apparent that both sets of recommendations have been based around core vaccines and non-core vaccines. Applying
this terminology will help practicing veterinarians make clear distinctions for their staff and help explain recommendations
to clients.
Core vaccines, by definition, are those that pose a serious health risk to every dog and every cat presented to the practice.
These are the vaccines that every dog and every cat will receive. And everyone in the practice knows that. Vaccines included
in this category are those that protect against highly contagious, life-threatening infections and/or zoonotic infections.
For the sake of consistency, everyone in the practice should know which vaccines are included in this category (Table 1, p.
36).
Non-core vaccines are perhaps best defined as those vaccines that, in the opinion of the clinician, should be made available
because infection poses a realistic, but variable, risk to individual dogs (Table 2). The decision to administer, or not to
administer, any of the vaccines in this category should be based on an assessment of the individual animal's health risk profile
and an effort to determine whether the patient is at low risk, moderate risk, or high risk for infection.
An additional category, not generally recommended, has been included in the AAHA guidelines to address those vaccines that,
based on available data, do not meet reasonable efficacy or safety standards (Table 3, p. 38).
The message here is quite clear: all patients do not share equal risk for exposure and infection. Obviously, it is impractical
to think that a single vaccination protocol can be designed to fit the needs of all patients. For the individual practice,
categorizing the list of canine and feline vaccines into these categories is an important and valuable exercise . . . implementing
guidelines, however, requires additional effort. Ideally, all clinicians in the practice will reach agreement as to which
vaccines are considered core. On the other hand, the decision over which non-core vaccines to administer entails selecting,
from a growing list of options, vaccine(s) on the basis of the individual patient's risk for exposure to the infectious agent.
Vaccination does, in fact, require a medical decision. What's more, health risk profiling is fundamental in deciding which
vaccines to use and when.
The health risk profile In the context of this discussion, "risk" is a subjective term used by the clinician to estimate the consequence of infection
in the individual patient following exposure to an infectious agent. Risk, therefore, is ultimately determined by a combination
of three factors:
1. Host Factors
2. Environmental Factors
3. Agent (or pathogen) Factors
All that considered, vaccination becomes a critical tool used to mitigate risk following exposure to an infectious agent.
Host Factors: The consequences of exposure to an infectious disease are expected to be worse among animals that are malnourished,
have concurrent infection or illness, or are receiving regular doses of immune suppressive drugs. Additional intrinsic factors
considered to influence the outcome of infection include heritable resistance (and possible susceptibility) factors and stress.
Age at the time of exposure is an important, independent variable in assessing an individual's risk to an infectious agent.
Although no age group can be considered entirely free of risk, dogs and cats less than 6 months of age are generally more
susceptible to infection than adult animals. Puppies and kittens, therefore, represent the principal target population to
benefit from vaccination. In the canine and feline guidelines, it should be noted that for both puppy and kitten vaccination
protocols, vaccine intervals and frequency are unchanged.
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