TexasVets Rabies Discussion

Rabies Discussion on TexasVets

Msg # 7111
Date: Mon Jul 15, 2002 4: 32 pm
Subject: Comments on a Wolf Rabies Case

Rabies is such an overlooked disease! Recently a client of mine had the unfortunate luck of having two cases of rabies in his extended family. Parents house had twenty or so cats, unvaccinated, one got bit by a skunk, developed rabies, bit the owner and daughter. They are under treatment. This client owns seven wolves located on a separate property. One wolf also became sick, subsequently died, and tested positive for rabies. All in all, four family members are undergoing treatment. The premises are not in proximity. The remaining six wolves have been euthanized.

Notable on the wolves, they were all vaccinated with Merial's 3yr vaccine
2-1/2 years ago. The owner had not kept up vaccinations because he felt there was much uncertaintyl about the effectiveness of the vaccine in non-labeled animals. Gee I think I told him that too at the time. I'm just wondering though, should the wolf respond to the vaccine closer to the dog's response, and if so, shouldn't we think very hard about only requiring rabies vaccination in our dogs and cats every three years?

I'm still voting for annual vaccinations.

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Msg # 7148

Subject: RE: [TexasVets] Comments on a Wolf Rabies Case

I have several clients who feed feral cats but do nothing else . I keep telling them to vaccinate for rabies but, they won't listen.

Now I have more ammunition next time I see them. Thanks M. About the wolves, it's my impression that the oral rabies vaccine used by Texas Dept of Health to curb rabies in south Texas is a Merial product in an oral form. Maybe Dr. F. can shed some light on this as I know he is on the list. Any comments G.???

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Msg # 7150

Subject: TDH Zoonosis Control Makes Rabies Decision

Drs: I spoke with Dr. Jane Mahlow, head of TDH's Zoonosis Control Division, yesterday and she has informed me that the Zoonosis Control Division has made its decision regarding its proposal to the Board of Health on the rabies vaccination issue. It is as follows:

All dogs and cats must be vaccinated against rabies by four months of age, revaccinated one year later, and then revaccinated no less than every three years thereafter.

This proposal will go to the Board of Health for discussion at its meeting on September 5th. If the Board votes to make the proposal the public will have 30 days to comment following its publication in the Texas Register. If all goes as the folks at Zoonosis Control would like, the new rule could go into effect in early January of next year.

I asked Dr. Mahlow if she planned on sharing the reasoning behind their decision and she said that she would probably post something on the TexVetMed list in the near future.

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Msg # 7153

Subject: Re: [TexasVets] TDH Zoonosis Control Makes Rabies Decision

I am very troubled by the ambiguity of the proposed ruling. What in the world does "revaccinate no less than every three years thereafter" mean? If one wanted to, this rule could be construed to allow revaccination every 3 days or 3 weeks or 3 years or what ever grabbed your fancy.

This rule will do nothing but generate confusion with in the eyes of the pet owning public and the profession. I can appreciate that Dr. Mahlow must have felt a lot of pressure from all sides of this debate and have really been on the hot seat but this issue needs clear cut guidelines. The proposed rule (I certainly wouldn't characterize it as a decision) seems to be an attempt to placate all sides of the vaccination debate at the expense of sound public health policy.

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Msg # 7155

Subject: RE: [TexasVets] TDH Zoonosis Control Makes Rabies Decision

Here is the text from a note I received from TDH a few minutes ago:

The rule under consideration would require dogs and cats in Texas to be vaccinated by a veterinarian by the time the animal is four months of age, given a booster one year later, then vaccinated at intervals of no greater than 3 years thereafter. Nothing precludes veterinarians from recommending more frequent vaccinations

. Either annual or triennial vaccines can be used as long as the vaccinations are administered according to label recommendations. Likewise, nothing prohibits cities and counties from making their regulations more stringent (they cannot make more lenient regulations).

My original message did not contain the information regarding the administration "according to label recommendations. " With that in mind, your particular practice could implement a policy of annual vaccinations instead of a triennial schedule.

However, your clients could choose to go elsewhere to get their vaccinations as they would not be required by law to vaccinate more often than once every three years. Hope that makes sense.

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Msg # 7160

Subject: TDH Rabies Recommendations

OH NO! ! ! The Texas Department of Health is going to require veterinarians to make Doctor-type decisions regarding the best interests of our patients. Why, oh why, can't they just let the government proclaim the rabies vaccine protocol, so we don't have to let a professional opinion creep into the doctor/patient/client/annual shot exam scenario.

Come on, y'all. Allowing the veterinarian to tailor the vaccine schedule to the patient is the best thing that's happened for us in a long time.

In my practice, I have many animals that I want to give a rabies shot to every year, but there are legions that never see the outside of a house. Now I can tell the client that it's ok to skip a year or so, and she won't be in violation of Texas law.

I welcome shades of grey in government regulations, because that give me leeway to interpret the rules to my patients (or my) best advantage.

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Msg # 7162

Subject: Re: [TexasVets] TDH Rabies Recommendations

While agree with your point, the down side is that now the public will be confused and we are going to spend a lot more time explaining to clients why clinic A has one recommendation, clinic B another, clinic C a third. They might interpret this non-uniformity as 'we do not have our act together' or some such negative thing. Can't win sometimes, it seems.

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Msg # 7164

Subject: TDH Rabies Recommendation

The issue isn't the Doctor or his decisions or relationships; its about public health and the decisions that owners make - the rabies only crowd in particular. Professionally we all know that that there isn't anything wrong with a 3 year rabies vaccination protocol; now just watch how many 3 year rabies vaccinations become 6 year vaccine protocols once the public is free to choose; the public dosen't even remember the regular annual vaccinations now and we as professionals can't come to agreement on that issue ! ! ! !

Rabies is certainly in a different class than distemper, parvo, lymes etc. If you are cheering our abilitiy now to choose a 3 year protocol for rabies then what about the rest ? ? ? Has there been any reason that someone with an elderly "house" pet has had to get annual vaccinations ? ? ?

I think we are back to the fundamental problem of whether we are about vaccinatios or examinations. If they are coming in for exams then the vaccination protocol can be tailored to your heart's delight. But the reality especially in the rural areas is that the vaccinations are the anchor points for practioners. This ruling is not only about the rural practicioner's situation its about public health; and where the problem will more likely occur - in the country - where "Bubba" now will have to be the front line defense by remembering whether it was last year or two years or five years or ten years ago . . . . . . . . "you mean they need vaccinations, Doc ? ? "

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Msg # 71165

Subject: Re: [TexasVets] TDH Rabies Recommendations

I agree with J. Clients are going to be VERY confused! They already get confused when they come to Texas and find out we vaccinate yearly. And these are the same folks that can't seem to understand how a 6 month supply of heartworm prevention lasts a whole year. But "they didn't MISS a dose"? ! ? ! Not them! : )

I applaud Jy that he can see a cup half full. I guess I am still too cynical and see it half empty. : (

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Msg # 7168

Subject: Hooray for 3 year rabies vaccinations

Now that the white plumes of smoke have wafted from the hallowed chimney of the Texas Department of Health Zoonosis Control Division, and their long anticipated decision on rabies vaccination intervals has been made public, I, for one, have found cause to rejoice and celebrate.

I must admit that, in the beginning of these discussions, I was a non-believer in 3 year rabies vaccination intervals. Now that TDH-ZCD has issued their statement, I feel much better. I have been assured that Texas is no different than any other state in its biology and ecology

. I detect confidence that the public health of the citizens of Texas will not be jeopardized in any way by a 3 year rabies vaccination interval. Shucks, when the next rabies outbreak occurs in Texas, we can simply hold 6-8 more meetings across the state, and in only one year's time, we can change the rule back to a 1 year requirement.

I must confess, however, that the thing that gives me the most joy is the cost savings to Texas taxpayers. All of the newspapers and even my own state representative have told me that this next legislative session will have to deal with an incredibly tight budget. All of the state legislators are looking for areas in which they can find savings. "How will a 3 year rabies vaccination interval save the citizens of Texas money? ", you might ask

. Simple. We now know that Texas is no different than any other state in its wildlife populations, rabies levels, or need to vaccinate more frequently than other states. Since I also know that the Texas Department of Health Zoonosis Control Division is an ethical, honest, forthright organization dedicated to consistency and fair play, and since I know that it is not politically correct to base decisions on rabies vaccination intervals on economic principles, and since I know that it is simply an oversight that this recommendation was not included with the original recommendation for a 3 year interval, I also have confidence that TDH-ZCD will do the right thing and recommend to the members of the Board of Health that they also drop funding requests from the Texas Legislature for annual aerial drops of oral rabies vaccine to wildlife.

By dropping these baits every 3rd year instead of every year, the citizens of Texas will realize a tremendous saving in the cost of the program and the employment of personnel utilized in the program. I will also sleep better knowing that no coyote will have to suffer vaccine reactions, AIHA, boils, flatulence, or any other as yet unidentified ill inflicted by evil vaccines. We dare not take a chance that a fox will ingest an oral rabies bait if he had just eaten one 2 years prior.

I know that TDH-ZCD will not try to use the unfair argument that they must maintain annual vaccination intervals for wildlife because the entire wild animal population has not yet been vaccinated. TDH-ZCD will not use this argument because they have told practicing veterinarians that such an argument is not valid for domestic animals.

So therefore, my disappointed and disgusted colleagues, take heart and look at this issue from another angle. When you ask your state legislators to fund the rural veterinarian loan forgiveness program and the legislator asks you where he/she can find the funds, tell them that Texas Department of Health will not need their funds much longer.

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Msg # 7172

Subject: Re: [TexasVets] Hooray for 3 year rabies vaccinations

Read your Rabies reporting lists lately? ! There is an epidemic in North Texas and that's with annual vaccination with three year vacc protocal! The feral cats that owners feed and refuse to vaccinate are the real culprit in this problem. IE its the owners that are the problem, giving them relaxed guidelines will not help the situation!

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Msg # 7179

Subject: Re: [TexasVets] Hooray for 3 year rabies vaccinations

Warning: If you can's take sarcasm, please don't read this!

Although it may not be politically correct to do so, I have to completely agree with Dr. Sheppard! Has anyone but me noticed the increase in the number of reported positive dogs and cats so far this year? I did a very quick search of positives in April in Texas. Along with the assorted rabies positive skunks, bats, raccoons, and other wildlife reported on a daily basis, there was a positive dog on 4/5, horse on 4/6, goat on 4/7, horse on 4/11, two cows on 4/16, and goat on
4/25 --- and this list is not complete.

So, do you know what's missing from this picture --- no HUMAN rabies cases in Texas for the last few years, YET. I think we are all missing the real political point of the exercise. In this era of cost cutting and budget constraints, all it will take is a few human cases of rabies in the state and the zoonosis department will be justified for years to come --- in fact, a few cases of human rabies couuld result in a department budget increase. Wow, if we get these numbers of positive domestic animals with an annual vaccination requirement, just think what will happen when the majority of pets in rural Texas never come back for vaccinations after their first shot!

I agree with those who think that the outcome of the "meetings across Texas" was decided long before the first meeting took place, but I went and tried anyway. At least when things start to happen I am on record with my views and opinions. I would like to see the actual numbers of people that spoke for each option along with some information about who they were; i. e. , if all the animal control people spoke in favor of annual vaccination, and all pet owners spoke against it, I think this in itself is very telling.

If TDH is not that worried about vaccinating pets against rabies, then I'm not going to be either. After all, I'm vaccinated so it is not a problem for ME. Just let me know when the new rules take effect so I can quit wasting my time with a "loss leader" in my clinic. The public can just go to the guy that has the parking lot van clinic and get the shot that will protect them for their lifetime with one dose.

TDH can take up where I leave off putting ads in the local paper reminding people about rabies vaccination, sending reminder cards, etc. I'll save money in the long run, and I won't waste so much time trying to convince folks that their farm dogs and feral cats need to be vaccinated. This is a win-win situation for both veterinarians and the TDH! We don't have to bother with rabies vaccinations anymore, and they ultimately get a bigger budget. Who could complain about that!

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Msg # 7180

Subject: 3yr rabies$$

Lets see, while we are being sort of facetious, how does this sound Exam fee35 with 1yr rabies vacc 5. 00$ exam fee 45$with 2yr rabies vacc fee 10. 00 exam fee 55$ and ? ? how much for this "valuable" 3 yr vaccine? ?

-- seriously why didn't they just go to a 2yr protocol, then it would be easy to do RV one year , DH? ? /FV? ? whatever the next. . sounds simple to me--so what is wrong with it? What about bites---quarantine-- those are going to be a pain for the people to understand when "they"got a 1 yr shot and it is 26 months. . . . "but I thought i got a 3yr shot from dr so and so over in XX townusa . . . .

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Msg # 7184

Subject: Re: [TexasVets] Hooray for 3 year rabies vaccinations

I'll put in my two cents worth on this issue. I've been practicing in Arizona for 10 years and rabies vaccination requirements are initial vaccine at 4 months, 1 year later and then every 3 years. Arizona has an endemic problem with rabies in fox, skunk and bats as well as sporadic coyote and raccoon cases.

There have been no cases reported in vaccinated pets although rabies has been found in livestock and unvaccinated cats and dogs. It would appear that every 3 years is effective in providing protection for cats and dogs.

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Msg # 7185

Subject: Re: [TexasVets] Hooray for 3 year rabies vaccinations

Scott, I'm glad to hear that 3 year rabies vaccinations appear to be adequate in Arizona. Just to be fair and consistent on the issue, do you know if they drop oral rabies vaccine from airplanes in Arizona? If so, are the baits dropped annually? We want to make sure that TDH stays true to its belief that Texas is no different than any other state in its need for rabies vaccination.

If every 3 years is adequate for domestic animals, it should be adequate for wild animals. If no aerial vaccines are dropped in Arizona, then, using TDH logic, aerial drops should not be necessary in Texas either. Now that I have seen the light on this rabies vaccine issue, I want to make sure that private veterinarians, the citizens of Texas, and the Texas Department of Health all share equally in the benefits of a 3 year program. I smell a windfall of savings for Texas taxpayers. Thanks,

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Msg # 7190

Subject: Re: [TexasVets] Hooray for 3 year rabies vaccinations

Baits are not dropped in Arizona. If you could assure adequate consumption of bait in Texas then every 3 years might be adequate.

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Msg # 7192

Subject: Re: [TexasVets] Hooray for 3 year rabies vaccinations

If we could just drop baits over the whole state of Texas every three years, maybe that would solve the whole problem! 'Course, who knows what kinda bait skunks like? !

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Msg # 7196

Subject: RE: [TexasVets] TDH Rabies Recommendations

<< the down side is that now the public will be confused and we are going to spend a lot more time explaining to clients why clinic A has one recommendation, clinic B another, clinic C a third. >>>

So what's new? ?

I don't think I've ever seen two clinics which have the same puppy or kitten vaccination protocol. If the TDH proposal is accepted, rabies vaccinations may be just like the rest--vary a little from clinic to clinic, with a legal
(and scientifically founded) minimum that must be met.

FEAR! FEAR! FEAR!

People who switched to biennial or triennial vaccines for DHLPP and FVCRP years ago know that this is, in general, not a problem.

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Msg # 7200

Subject: RE: [TexasVets] Hooray for 3 year rabies vaccinations

<< Shucks, when the next rabies outbreak occurs in Texas, we can simply hold
6-8 more meetings across the state, and in only one year's time, we can change the rule back to a 1 year requirement.>>>>

I don't think that vaccinating pets has very much to do with controlling rabies outbreaks. Rabies outbreaks in Texas come from wildlife reservoirs, not from pets, and the only way to control them is to vaccinate/eliminate the reservoirs. The rabies problem has gotten steadily worse in Texas despite vaccinating pets yearly with a triennial vaccine for decades. Maybe there is a message for us there. . . . .

Vaccinating pets does have to do with protecting people, should an outbreak occur, and I agree that is of utmost importance. However, vaccinating Fifi more often than needed is not likely to help. We've got to get to the pets who are not being vaccinated at all in order to make a difference.

And these pet owners are not and have never been on our "reminder" list. I'm not sure that veterinarians can reach these people effectively. Maybe well advertised rabies vaccine clinics, public information campaigns, etc. , might help. I would bet that most people who don't vaccinate their pets have TV's in their homes. I have never seen a public information commercial on rabies control--don't know if that has ever been done, but it might be effective. Then again, I don't watch much TV. . .

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Msg # 7201

Subject: 3 year rabies vaccinations decision

I must say that I have been in that group that feels the system isn't broken, so why fix it. Seeing all the Rabies lab reports from nearby counties. . . vaccinating for so long every year. . . most of us felt like we were really doing the right thing for our patients. Then out of all the discussion . . . back and forth. . . you made a comment that really made me stop and think about what is really "right" here. You said:

"Someone PLEASE explain to me how REQUIRING veterinarian to vaccinate pets who are already protected could possibly help control rabies? ? ? "

That is really the arguement in a nutshell. . . if the "already protected" part is true. . . then you are absolutely correct. That one statement is enough to make me consider switching sides on this. BUT, I have to object to the later comment about US bamboozling clients. I am not out to bamboozle anyone. . . I try to practice good medicine just like a majority of vets in Texas who are still un-convinced about this 3 year protocol being a good thing for vet medicine. There are lots of differing opinions out there on this matter, but it doesn't make us guilty of some kind of intentional cover-up in the rabies vaccination market. Thats how I interpret your "bamboozle" comment. FWIW.

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Msg # 7203

Subject: RE: [TexasVets] 3 year rabies vaccinations decision

This reply is full of personal opinions and feelings, so if you are interested in "just the facts m'aam, " you might want to skip this one.

<< I must say that I have been in that group that feels the system isn't broken, so why fix it. >>

I guess that from my perspective, the system IS broken. We have been vaccinating yearly with triennial vaccines for decades, and rabies is increasing despite this practice. To, me, this sends a message loud and clear that we must change what we are doing. Overvaccinating pets is clearly not an effective way to control rabies, and from my unique perspective I can't justify doing it.

When asked by an owner, "What caused this? ", I have had to look more than a dozen devoted clients in the eye and tell them that their pet has died, or has a life threatening illness that may have been or was likely caused by a vaccine. Interestingly enough, in every case I have been involved with except one (a puppy developed IMHA 10 days after vaccination), scientific studies have shown that he/she really didn't have a medical need for the vaccine at the time it was given.

Maybe I've seen a good bit more of this than the average practitioner because I do referral work, or maybe my clients are just more unlucky than average. But every time I have to do it, I am even more convicted that I want to minimize my role in causing the problem, no matter how rare it might be. And I promise myself that I will make every effort to NOT vaccinate pets without proper informed consent, and without good reason.

Unfortunately, lack of informed consent for vaccines probably is the current standard of care. Informed consent is suggested by AVMA Guidelines, and is required by law in many states, yet in general it is not done with respect to vaccines. I personally have the biggest problem establishing informed consent with clients who have dropped their pets off for annual exam and vaccines--this is where I am still dropping the ball, and need to work on a better solution.

Maybe I need to write that Vaccine Informed Consent handout that Jim W assigned to me a few months ago, so that can be given to owners who drop off. In my experience, not one of the dozen or so owners of pets with potentially life threatening or fatal vaccine reactions received informed consent about the potential risks of vaccination (no matter how small), nor the medical indications or lack thereof for vaccination of their pet. One of the pets that died of an acute vaccine reaction was vaccinated by me--with no informed consent.

It was an older adult dog who received a 3 year rabies and DHPP--both which had been given the previous year. I now know that dog had a high probability of already having strong immunity to all diseases vaccinated for (except lepto--but that is another discussion), and may well have died for nothing. That doesn't sit well with me, and it certainly is less than congruent with, "above all, do no harm. "

<< BUT, I have to object to the later comment about US bamboozling clients. I am not out to bamboozle anyone. . . >>

I am truly apologetic if this sounded accusatory--it was not meant to be at all. I said "we, " but probably should have sad "I. " I have no doubt that most vets who are continuing to vaccinate yearly with triennial vaccines are doing so because they believe it is the right thing to do. But I don't happen to believe it's the right thing to do, so when I am forced by law to do so every day, especially when I find myself in a situation where I failed to create the opportunity to speak with the owner to give them proper informed consent (a drop off, a boarder, etc. ), and I go ahead and vaccinate, I truly feel that I have bamboozled my client, and I don't like it.

They are depending on me for good advice and good health care, and they did not get "the rest of the story. " Every day, I look people in the eye just before I give the triennial rabies vaccine to an older adult pet who received the same vaccine last year, and tell them that there is likely no medical reason for the vaccine, yet Texas Law requires me to give it.

Many times, I don't get much of a reaction, but every once in awhile someone is incensed that they are required by the State government to put their pet at risk (no matter how small), while likely not appreciably increasing protection from disease. Many on this list have argued that requiring yearly vaccinations (more often medically needed) is OK, based on the idea that those who vaccinate less frequently than required might be tricked into making it in every 3 years and be fully protected. To me, that's being less than honest, and that's what I meant by "bamboozling. "

<< There are lots of differing opinions out there on this matter, but it doesn't make us guilty of some kind of intentional cover-up in the rabies vaccination market. Thats how I interpret your "bamboozle" comment. FWIW. >>>

Please don't think that I was saying that I think that you or any veterinarian who continues to use triennial vaccine every year is by definition "bamboozling" their clients. " If you'll review my post, you'll see that I did not say that at all, and in fact didn't even think it for a minute.

I was simply objecting to the practice mentioned many times on this list of misleading all clients into thinking their pet actually has a medical need for a yearly triennial-type rabies vaccine, hoping that the less-than-ideal clients will come in every three years or so for a triennial rabies shot. I would prefer to be more honest and direct about what is actually medically indicated for each pet. I may be naive, but I have often found that treating others with respect and honesty results in the same in return, and is a good starting point for effective communication.

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Msg # 7204

Subject: RE: [TexasVets] Hooray for 3 year rabies vaccinations

Please excuse my recent frivolity on the rabies vaccination issue. It was my lame attempt at finding some humor on the issue. I guess that I was also expressing some frustration with the process the TDH used to develop their final recommendation. When the process began, we were lead to believe that TDH wanted input from the public and from veterinarians.

After hearing hundreds of veterinarians across the state support continuation of an annual rabies vaccination requirement, the Zoonosis Control Division issued a recommendation unchanged from their original statement. The meetings and request for response seems to have been a colossal waste of time.

Furthermore, I contend that there are at least two serious points hidden in my sarcasm. First of all, it is apparent that the Zoonosis Control Division deems Texas' rabies problem to be different from that in other states, at least as far as their support or oral rabies vaccine drops. I found it a little peculiar that ZCD does not see Texas as any different from Arizona when it comes to vaccination of pet animals, but they do ascribe a difference to Texas in its need for more vaccination of wild animals.

The second point that I think was made is the fact that veterinarians have been told not to worry about how a change in vaccination protocol will affect their pocket book, and cities and municipalities have been told not to consider how this change will affect their collection of annual animal license revenues. I would contend, however, that TDH would fight tooth and nail to preserve their annual funding for aerial drops of oral rabies vaccine.

I have attempted in a round about way to demonstrate to TDH that there is a potential for charges of hypocrisy on their part in these two areas.

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Msg # 7205

From: [email protected] Date: Fri Jul 19, 2002 9: 27 am Subject: Rabies Vaccination

I don't fully understand why people think that rabies in Texas is so different than rabies in the rest of the United States. Yes we had Coyote variant in this state, but the ORVP program has successfully pushed it back to Mexico. (The oral vaccine is an entirely different topic than what we give pets - no one is suggesting changing its frequency). I recently completed a surveyed all of the state health departments for rabies control measures, including frequency and type for both dogs and cats. There are only five states in this country that require annual rabies vaccination.

(Texas, New Mexico, Louisiana, Arkansas and Alabama). According to the CDC's tally of reported rabies cases, Texas is the only one of the five with a high incidence of rabies. For dogs, 29 states permit vaccinating according to vaccine label and 12 have no laws requiring rabies vaccination.
..
For cats, 22 states permit vaccinating according to vaccine label and 21 have no laws requiring rabies vaccination. When you compare state vaccination laws with reported cases, you see that the eastern seaboard with its high rate of racoon rabies requires vaccinating according to label directions. A few of these states vaccinate dogs every two years. The upper Midwest, with its skunk strain epizootic, has lots of states with no rabies vaccination laws at all. Despite their laws, they do not have higher rates of rabies in their domestic animals.

The question is if differences in laws cause differences in owner compliance. States with higher rates of rabies in wildlife than we have and looser vaccination laws don't have higher rates of domestic animal rabies than we have.

I will grant that Texans are different than Vermonters, but I don't think they are that different. I've read lots of posts suggesting that the sky will fall if Texas changes its laws, but it hasn't fallen in the rest of the country

. I've also read posts suggesting that we will confuse the poor pet owner if I vaccinate at a different frequency than you do. My clients are already confused because they know that the vaccine is labeled for three years and given annually.

In my experience, if you can give your clients a valid reason for why you do it differently than the clinic down the street, they will accept it. If your reasons are more about profit and convenience then you might have a harder time. To see the CDC map of rabies incidence rates go to http: //www.cdc.gov/ncidod/dvrd/rabies/Epidemiology/Epidemiology.htm.

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Msg # 7209

Subject: Differences between public - private rabies programs

Dr. G. F wrote

. . . . "The real objective of an oral rabies vaccination program for wildlife is "herd immunity" and that differs greatly from a vaccination program for domestic animals that has been mandated out of public health concerns. Hopefully, with proper guidance, in the future those programs will be structured with concerns for vaccine efficacy, safety, duration of immunity and include considerations of owner compliance in our highly mobile society. "

It kind of sums it up. There are differences. I understand Wendy's point about over vaccination. The rabies vaccination shouldn't be the cornerstone of our profession but it can be the most highly visible. From the scientific aspect I agree totally with Wendy but then there is the public perception about our professional skills and knowledge that needs vast overhaul. We had 3 year rabies vaccinations in New York 30 years ago; I never remember any problem with

vaccination protocol in the public perception but I do believe that I have seen it here in Texas.

Rural practices tend to have clientel that is geared to the rabies vaccination for yearly (semi-yearly, often, once in a life-time)exam. There is an expectation by clients. It should be based on the exam not the vaccination so I agree with WB but TDH will not be there to clean up the mess that it leaves us with. Vaccinations are like insurance policies; would it have been so bad to leave the regulation alone so as to maintain the policy for human life. Its too bad that the professional discussion which should support the TDH decision based on science has to be skewed by the practical economics of day to day practice but that's thems the facts. . . .

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Msg # 7210

Subject: Using triennial vaccine for annual vax

I guess I missed something in the earlier posts.

Why would you use triennial vaccine for annual vaccination and then complain about the TDH protocol ? ? ? I must be a little overheated with the summer weather.

You have now a protocol that says you can vaccinate every 3 years and then when the client comes in for vaccinations you use triennial vaccine ? ? ? Why not use an annual vaccine ? ? ? ? If you have the animal coming in for vaccinations anyway - the others are labeled for annual use why not just give those and skip the rabies if you have given the triennial the first year ? ? ? ?

I have to agree with WB for sure if the question is using a triennial vaccine; it does seem like overkill. The issue of clients only coming in for the 3 year vaccination is perhaps moot if you tell clients up front that you are using a 1 year product because you feel that they need it in your area and you have a good enough relationship with them to have compliance with annual visits . . . . .

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Msg # 7211

Subject: Re: [TexasVets] Using triennial vaccine for annual vax

Aren't we still required by law to use the 3 year rabies vaccine in all dogs? Will that requirement change with the new regs?

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Msg # 7214

Subject: Rabies Vaccination Frequency

Comments from WBy & M are right on target. Over vaccinating a small part of the population does nothing to stop an outbreak. The old standard that I remember was that 70% of the dog population needed to be adequately vaccinated to do that. That was without the knowledge that we have now of the relatively species specific strains of rabies. In San Antonio, estimates are as low as
30% vaccinated animals. The real need is to get out and get some vaccine into the unvaccinated ones. I don't believe tripling the necessary frequency will get that done.

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Msg # 7216

Subject: 3 yr non adjuvanted vaccine for cats

In reply to Dr. J, correct me if I am wrong, but IS there a 3 yr, non adjuvanted vaccine for cats? I am only aware of Purevax by Merial, and I think it is a one year. I am not willing to go "extra label" on rabies yet!

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Msg # 7218

Subject: Feline Rabies Vaccine

I think you are correct S. I didn't see anything in the 2002 Compendium on rabies vaccines to dispute that. Under the likely TDH proposed rules, you can use any approved vaccine for its published duration of immunity. If I were buying vaccine & setting schedules (which I don't as a relief veterinarian), I would probably use Purevax annually in cats & a different vaccine with 3 year duration of immunity in dogs to comply with the new proposals.

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Msg # 7305

Subject: Rabies cases/vaccinations

I thought I would forward my response to an "alert" that was put out by TDH. Maybe someone can make some sense of this situation. It seems crazy to me that TDH will warn us of "the Rabies" problem in one particular region of the state, but will simultaneously change the rabies vaccination protocol for the entire state to a "less stringent schedule. The "alert" from the TDH will follow and my response will be after that. (the chart that is referred to is not included)

This message is being sent to stakeholders (listed below) in Public Health Region 7 for whom I have E-mail addresses:

Animal Control and Welfare personnel County Agriculture Extension Agents Community Infection Control personnel Federal Park and Lake Supervisors Local Health Authorities Local Health Dept. Directors Local Health Dept. Epi Contact personnel Medical Societies PHR7 Military Contacts PHR7 Clinic Nurses PHR7 Communicable Disease Team Members Texas Animal Health Commission Area Directors Texas Parks and Wildlife Majors Texas Wildlife Damage Management District supervisors TDH Zoonosis Control Personnel Statewide USDA Animal Care Inspectors Veterinarians Zoos

"Rabies Case Numbers Keep Climbing in Central Texas"

As of yesterday morning (7/23/02) we had 175 laboratory-confirmed animal rabies cases in Public Health Region 7 (the 30 counties of Central Texas). This equals ALL of the cases reported for the year
2001 in PHR7.

Attached is an Excel spreadsheet with three pages of tables and a histogram that describes these rabies cases by county and species and by a three-year comparison.

These PHR7 rabies cases are being caused by the skunk rabies strain, in all animals except bats (which have the bat strain). Of note is the rabies spillover from skunks into cattle (8 cases), dogs (4 cases), wolf-dog hybrid (1 case), and cats (5 cases). The 175 animal cases have resulted in numerous human exposures and the treatment of these persons with rabies postexposure vaccination series.

Because of the increase in rabies cases this year in Central Texas, I have asked the TDH Office of Communications to distribute a press release to inform the public of the situation and to make offer general recommendations to the public regarding rabies prevention.

You should anticipate this press release will promote media coverage and animal rabies awareness. Please be prepared to promote animal rabies vaccinations, animal bite reporting, testing or quarantine of rabies suspect animals, and the enforcement of animal restraint laws. Thank you.

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Msg # 7306

Subject: Re: [TexasVets] Rabies cases/vaccinations

To Whom It May Concern:

Why not vaccinate our pets every 6 months against Rabies. Then we can be doubly sure that they are protected.

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Msg # 7307

Subject: RE: [TexasVets] Rabies cases/vaccinations

Several times a year I have various clients come in stating they saw a skunk in their yard at high noon. Usually they live in the country where fences to contain pets are taboo. They wonder if they need to be concerned about their pets and rabies. It does me and them a lot of good when I can look at the pet's chart and say "Mrs. Jones Fido has had Rabies vaccinations for the last 3 years with 3 year vaccine. At least you saw that skunk. We are determined to protect your pets even from the skunks you don't see. You don't have anything to worry about and neither do your grandchildren. " It's one thing to talk about going to 3 year vaccines for Distemper, Feleuk, or Parvo but, when it comes to rabies I don't want to mess around. We had a rabid dog in our clinic 3 years ago and it was not fun.

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Msg # 7309

Subject: RE: [TexasVets] More Vaccination is not always better

So what is the rationale behind assuming that using a triennial vaccine yearly is more effective than using a triennial vaccine triennially? ? ? Vaccinating more often than recommended on the lable does NOT always result in increased immunity. As with many >things in veterinary medicine, more is not always better.

Here is an interesting study that showed that dogs vaccinated repeatedy for DHPP and/or rabies between 8 weeks and 4 years of page showed no increase in IgA, IgM or IgG against the antigens vaccinated for after one year of age. On the other hand, repeating rabies vaccination at 2 and 3 years of age did increase IgE levels. I realize that this is not a challenge study, but some have interpreted this study as being suggestive that repeated vaccination after adulthood might increase adverse vaccine responses (IgE) without increasing immunity to disease (other immunoglobulins). Food for thought.

Effect of vaccination on serum concentrations of total and antigen-specific immunoglobulin E in dogs. Am J Vet Res 63[4]: 611-6 2002 >Apr. HogenEsch H, Dunham AD, Scott-Moncrieff C, Glickman LT, DeBoer DJ. OBJECTIVE: To determine the effect of vaccination on serum concentrations of total and antigen-specific IgE in dogs. ANIMALS: 20 female Beagles. PROCEDURE: Groups of 5 dogs each >were vaccinated repeatedly between 8 weeks and 4 years of age with a multivalent and rabies vaccine, a multivalent vaccine only,
or a rabies vaccine only.

A fourth group of 5 dogs served as unvaccinated controls. Serum concentrations of total immunoglobulins >and antigen-specific IgE were determined following vaccination. RESULTS: -The multivalent vaccine had little effect on serum total IgE concentrations. The concentration of IgE increased slightly following vaccination for rabies at 16 weeks and 1 year of age and increased greatly after vaccination at 2 and 3 years of age in most dogs, with a distinct variation between individual dogs.

Vaccination had no effect on serum concentrations of IgA, IgG, and IgM as measured at 2 and 3 years of age. The rabies vaccine >contained aluminum adjuvant in contrast to the multivalent vaccine.

An increase of IgE that was reactive with vaccine antigens, >including bovine serum albumin and bovine fibronectin, was detected in some of the dogs vaccinated for rabies. There was no significant correlation between serum concentrations of total IgE and antigen-specific IgE following vaccination.

Serum total IgE concentration rapidly returned to preimmunization concentrations in most dogs, but high concentrations of antigen-specific IgE >persisted.

CONCLUSIONS AND CLINICAL RELEVANCE: Vaccination of dogs for rabies increases serum concentrations of total IgE and induces IgE specific for vaccine antigens, including tissue culture residues. Vaccination history should be considered in the interpretation of serum total IgE concentrations.

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Msg # 7310

Subject: RE: [TexasVets] More Vaccination is not always better

WB, Years ago when the state of TX announced the state quarantine for rabies and then required us to vaccinate w/the triennial vaccine annually, I think the intent was to protect those pets that aren't brought back in on time(yearly in this case) for the vaccine. If we use the triennial vaccine triennially and the O is late bringing the pet in, is there research that shows the pet will still be protected beyond the 3 years?

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Msg # 7311

Subject: Re: [TexasVets] Rabies cases/vaccinations

Greetings from the TAMU Class of '88 Texas Remnant.

You know, I think the reason that so many of us are reluctant to change is that we are COMFORTABLE with annual rabies vaccinations. It has been done for years and I personally do not know of breaks in pets properly vaccinated on an annual basis. Because of the risk involved if triennial vaccine does not work, I am concerned. I believe that in 10 years, we will all look back and laugh at our reluctance to change.

Personally, I would dance for joy if I never administered another vaccination. I don't use corona, rarely use lepto, and don't vaccinate for FELV if it is an indoor cat. But I am scared of rabies. I still vividly remember the film we saw in vet school of the young boy infected with rabies. To me it comes down to how many animal lives I would have sacrificed to save that child's life. I do not know. A lot though.

And yes, I know this is an extreme example. But I think we would agree that we do not know exactly how long the vaccination provides protection. 1 year? 3? Probably longer, at least in most animals. My fear is that the public will make the decision that hteir pet does not need the rabies vaccination without a veterinarian's input. I have already had people come in and ask me if it is true that dogs don't need rabies vaccinations anymore.

Those we can educate, but what about the ones that don't bother to come in at all? Won't that contribute to a growing pool of never vaccinated PETS? Just today a couple came in with a 4 month old puppy. Would not allow a rabies vaccination.

Have at least one other pup of the same age at home that has no rabies vaccination. I don't know about Phoenix, but that is not uncommon in Henderson. I really believe that these people will think that if the law says 3 years, then never will probably work. Or they will slip across the border to Lousiana and buy the rabies vaccination OTC as some do already.

It is a tough decision that I struggle with. I understand the science. It is the putting into practice that I am unsure about. I agree that we need to do a better job of educating our clients about the possibilities of side effects in many of our vaccines and medications.

We did not automatically say yes when our pediatrician recommended chicken pox vaccination for our daughter. We thought about it and discussed it with her. Children die following that vaccination. But we did go ahead after weighing the pros and cons. As our pets become increasingly important members of our households, I see that discussions of that nature need to become the rule rather than the exception.

I appreciate your input from a state that currently uses triennial vaccinations, as well as someone whom I know and respect. I hope that you and others closer to academia than I am will bear with those such as myself as we make this transition.

BTW, can you tell me again why we do not use Vitamin C as an urinary acidifier? : )) (inside joke, TAMU Class of '88)

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Msg #7312

Subject: RE: [TexasVets] Rabies cases/vaccinations

<< I think the reason that so many of us are reluctant to change is that we are COMFORTABLE with annual rabies vaccinations. It has been done for years and I personally do not know of breaks in pets properly vaccinated on an annual basis.

Agreed. But let's really think about this. Is being comfortable a good enough reason to keep doing what you are doing, even when the available data shows that it may not be appropriate? There is solid scientific evidence that three year rabies vaccines protect for A MINIMUM of three years--maybe even life (no one has checked beyond three years).

In 1996, there were 308 laboratory confirmed cases of rabies in wildlife (92. 5%), 15 (4. 5%) in dogs and 10 (3%)in cats. In 1997 and 1998 there were less than 300 total, with similar breakdown. In 1999, there were 346 in wildlife (91%), 13 (4%) in dogs and 21 (6%) in cats. In 2000, there were 774 in wildlife (95. 6%), 19 (2. 3%) in dogs and 17 (2. 1%) in cats.

The rabies problem in wildlife has gradually grown for decades, and only in the past few years (as it has begun tow grow more rapidly) have we begun to address it with the oral rabies program. Rabies was eliminated from Switzerland by a wildlife oral rabies vaccination program in the late 1970's to early 1990's. Pet vaccinations were never part of the plan. Switzerland is now rabies free, and has been since 1996, after more than 30 years of endemic rabies.

Had we started dropping oral rabies vaccine bait when Switzerland did, we too might be rabies free.

<< Because of the risk involved if triennial vaccine does not work, I am concerned.>>>

But there is solid data that triennial vaccines DO work for at least 3 years. Why would you doubt it? There are only 5 states that require yearly rabies vaccination, and not all of them require triennial vaccines to be used. Rabies in pets has not run rampant in the other 45+ states, several which have more rabies per square mile than we do. Why would we expect it to happen here?

<< But I am scared of rabies. I still vividly remember the film we saw in vet school of the young boy infected with rabies.>>>

I am scared of rabies, too. But fear of rabies does not make me want to vaccinate pets three times more often than needed, any more than shooting a poisonous snake two times after it is already dead makes it any more dead. Cultivating a healthy sense of paranoia can sometimes be good, but just make sure that the fear doesn't cause you to overreact.

<< But I think we would agree that we do not know exactly how long the vaccination provides protection. 1 year? 3?>>>

Not me. I think there is pretty solid data that 3 year vaccines protect for at least three years, and who knows how much longer. I don't think there is a good reason to question this. 45+ other states, most of the veterinary professional associations, and almost all of the vets schools don't. Why should Texans?

<< My fear is that the public will make the decision that their pet does not need the rabies vaccination without a veterinarian's input. I have already had people come in and ask me if it is true that dogs don't need rabies vaccinations anymore. Those we can educate, but what about the ones that don't bother to come in at all? Won't that contribute to a growing pool of never vaccinated PETS?>>>

I really think that we have CREATED part of this problem by insisting on vaccinating yearly with a vaccine that clearly lasts at least three years. People are beginning to get wind of it, and it doesn't make sense to them--it makes them suspicious of veterinarians. I asked four different clients recently what they think the reason for using a triennial vaccine yearly could be, and all four IMMEDIATELY responded--MONEY! ! !

I honestly would not be surprised if most vets who still think yearly vaccination is the way to go think so for reasons other than financial, but nevertheless that's the public perception in my experience. I think what is happening is that the public is looking at the issue much more objectively than we do, and they just can't understand why anyone would administer yearly a vaccine that lasts for at least three years. Frankly, I can't understand it, either.

<< I really believe that these people will think that if the law says 3 years, then never will probably work.

Talk about paranoia. . . . . ; -)

From the TDH WhitePaper on rabies
(http: //www.tdh.state.tx.us/zoonosis/veterin/whtpaper.pdf):

In an attempt to see if a difference in delinquency rates exists between states requiring rabies vaccination each year and states requiring rabies vaccination every three years, TDH obtained data from Banfield Corp. Banfield provided data from seven states in which they have clinics ( 1 year states TX and FL and 3 years states AZ, CA, IL, NC and SC).

The data contained vaccination status of 1. 6 million dogs and 582, 000 cats, based on a form completed by there veterinarian stating whether vaccination was given early, late or on time. When looking at the "rabies only" people, who seem to be the greatest concern, comparison of 1 year states to 3 years states shows no significant difference in delinquency rates.

<< I understand the science. It is the putting into practice that I am unsure about.>>>
That's where you lose me. If you understand the science, and you think that we will look back on this in 10 years and wonder what we were so worried about, then how can you possibly do anything BUT change?

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Msg # 7313

Subject: RE: [TexasVets] More Vaccination is not always better

<< Years ago when the state of TX announced the statequarantine for rabies and then required us to accinate w/the triennial vaccine annually, I think the intent was to protect those pets that aren'tbrought back in on time(yearly in this case) for thevaccine.

If that was the intent, I don't think it was based on any data--probably sounded like a good idea a the time.

BUT. . . a TDH study shows that this thinking is probably not valid:

From the TDH WhitePaper on rabies
(http: //www.tdh.state.tx.us/zoonosis/veterin/whtpaper.pdf): In an attempt to see if a difference in delinquency rates exists between states requiring rabies vaccination ech year and states requiring rabies vaccination every three years, TDH obtained data from Banfield Corp. Banfield provided data from seven states in which they have clinics ( 1 year states TX and FL and 3 years states AZ, CA, IL, NC and SC).

<< If we use the triennial vaccine triennially and the O is late bringing the pet in, is there research that shows the pet will still be protected beyond the 3 years?

There is one manufacturer study on three year vaccine in cats that shows 100% protection at 44 months, according to the above TDH rabies whitepaper, so I think we can be very comfortable that cats who are 8 months late on their triennial vaccine are still well protected. But there is no data in dogs. For some reason, veterinarians talk about 3 year vaccines as if after 3 years immunity magically and immediately begins to wane, until the pet is completely unprotected at 4 years post vaccination.

It's possible that immunity is significantly reduced at 4 years. It is also possible that immunity is lifetime. The vaccine manufacturer may have DOI information for longer than 3 years, but they are under no obligation to share it if they do, and it would probably not be in their best interest to prove to anyone that their vaccines should be used less often than they are. Because of the hazards of dealing with virulent rabies virus, I seriously doubt that any independent studies ever will be done. So we may well never know.

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Msg # 7317

Subject: Re: [TexasVets] Rabies cases/vaccinations

I agree the vaccination schedule are going to change as there is becoming some good science behind the data. I guess the big thing is getting the veterinarian and the owner used to the changes.

That Yearly vaccination is instilled in owner and going to take some time to change. I have been using less and less vaccine and trying to make the visit more orientated to the annual physical. I am still amazed when I ask the reason for today's visit they still say he is here for shots. I think we need to hear from more that are making changes on there protocol . Heck I would like to see what type of program that tamu or private practices use then ones I have seen so far looks like it just picking questionable service to fill the void left over by the vaccine removal.

Since it was before my time I am not sure how the vaccine exam became so ingrained in people mind but yet the major surgery such as an ohe , neuter became casual. I probably said this before but I was at a meeting in quinlan Texas at the east Texas veterinary association .

The president ask people to write down what it cost to suture a 2 inch skin laceration. Most charge more for that than for an ohe. I think this is going to have to change and start charging what a major surgery should cost heck my town is just as bad as we still have poor priced on ohe. I think vet are going to see decrease vaccination and pharmacy sales and as Dr. Jerry Skidmore has taught me we are going to have to earn a living being veterinarian's not drug salesman or vaccine distributor .

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Msg # 7319

Subject: Re: [TexasVets] Rabies cases/vaccinations

You may have had a rabid dog in your clinic but I would bet money that it had never been vaccinated a single time.

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Msg # 7322

Subject: RE: [TexasVets] Rabies cases/vaccinations

Hi WB,

I did a poor job of expressing my concerns. Let me try again. I really am not worried about the vaccine lasting three years. I believe there is plenty of documentation that immunity is conveyed for at least 3 years. However, I see people that think they only need to come in after 6 months of age or 1 year of age fairly often.

That is the population I worry about. Maybe we would be better served by going into the community and rounding up the never vaccinated pets and getting at least one dose in them. After reading Scott's comments about how things are in Arizona and the study you sent to the list showing no significant differences in the delinquency rates, I do feel better. I did not say I was not going to change, but that I was a bit uncomfortable doing so.

Anyway, I am going to try to pull myself from my fog of paranoia long enough to stop bamboozling(sp? ) clients long enough to go eat lunch. : ))

Thanks for the input,

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Msg # 7323

Subject: RE: [TexasVets] Rabies cases/vaccinations

Hi Jim!

<< I did a poor job of expressing my concerns. Let me try again.

I think you did a great job. I just couldn't let the comments about questioning the efficacy of the vaccine go by without making some sort of response. Maybe if I would learn to heedmy other's advice about not saying anything at all if you don't have something nice to say, I would be a lot better off.

<< However, I see people that think they only need to come in after 6 months of age or 1 year of age fairly often. That is the population I worry about.

I agree that this is a real problem, but I don't think that frequency of vaccination -- every year, or every three years -- will have much of an effect in this issue. For some reason, we really haven't done much in the way of public education on the need for rabies vaccines--it's probably way past time we do. Just another thing to add to the list of things to do. If we could just get a greater percentage of the pet population vaccinated for rabies even once or twice in their life, I think we would be a lot better off.

<< Anyway, I am going to try to pull myself from my fog of paranoia long enough to stop bamboozling(sp? ) clients long enough to go eat lunch. : ))

Bamboozlement has a long history in veterinary medicine. Radiologist and pathologists are especially adept at it, and internal medicine types don't follow far behind. A real quality bamboozlement is way above and beyond a hoodwink, because the information is delivered so elaborately and so eloquently delivered that the "bamboolzee" has no idea that he or she was actually taken by guile. What we really have to be careful of is the "double whammy bamboozle. " This occurs when the bamboozler becomes so taken with his or her art form that he or she is actually unwittingly transformed into a bamboozlee ; -).

Gotta go weave some tangled webs myself, and bamboozle a Boxer owner into using CCNU to treat his dog's mast cell tumor. No survival studies on mast cell tumors and CCNU in people or dogs, just one little ole study that showed that CCNU shrunk otherwise untreated mast cell tumors in 50% of a small group of dogs. Yet all of the oncologists are using CCNU as their first line of chemotherapy for mast cell tumors. Guess there aren't any other choices that are proven to be better. Yeeesh. . . .

Have a good day!

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Msg # 7324

Subject: RE: [TexasVets] Rabies cases/vaccinations

I still didn't get across what I wanted to. Last try. I think you did a great job. I just couldn't let the comments about questioning the efficacy of the vaccine go by. I don't question the efficacy of the vaccine.

You stated what I am trying to say very well. We need to get the never vaccinated dogs and cats vaccinated. We do not want to increase the pool of animals that do not get vaccinated. I'm just not sure that the way things have gone so far is the best way to educate the public. It is almost as if the state agencies involved floated a trial balloon to gauge public opinion rather than make a decision based purely on science. If they are making the best decision, why do they want public opinion(veterinary or general)? OK, now I am getting cynical on top of paranoid and bamboozlistic.
(In the future, could you find words easier to spell to throw out)

Well, one informed choice I've found many clients to make in East Texas is the IIAHIGAR. Only anecdotal data to date, but many do seem pleased. Oh, that is the Ignore It And Hope It Goes Away Regimen.

Tell JW to hurry back before it gets quiet enough for me to post again.

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Msg # 7325

Subject: RE: [TexasVets] More Vaccination is not always better

"Better to remain silent and be thought a fool than to speak out and remove all doubt. " --- Abraham Lincoln

I know that I should heed President Lincoln's great advice but I do have a comment/question regarding the Banfield survey that is contained in the TDH white paper. I think this survey would be much more relevant if Texas' rules currently required annual vaccinations with a one year vaccine and we were considering changing to triennial vaccinations with a three year vaccine. But that isn't the case as Texas currently requires annual vaccinations using the three year vaccine.

In either a 1 yr/1 yr state or a 3 yr/3 yr state I assume that a dog that is 6 months late for its revaccination is no more or less protected under either protocol --- in both instances the dog is 6 months beyond the immunity period stated on the bottle. However, by going from a 1 yr/3 yr rule to a 1 yr/1 yr or 3 yr/3 yr (as is the recommendation of Zoonosis Control) there is a real difference. In Texas today, if a person is 6 months or even a year late in getting his or her dog revaccinated the dog is still within the immunity period stated on the bottle.

From reading other posts on this issue I realize that both the 1 yr and 3 yr vaccine probably last longer than the stated duration. However, in all of the meetings on this issue that I attended it was emphasized that this decision was going to be based upon science. Therefore, it would seem to me that it would be unscientific to assume that the vaccine lasts any longer than the data has shown. I would therefore argue that there is a serious difference between those who are delinquent in Texas and those who are delinquent in those states who vaccinate strictly according to the label. We currently have a two year "buffer" in dogs in Texas that will be eliminated if the recommended changes are approved.

I guess this is really more of a "human nature" argument than a scientific one. I think it is clear that a certain number of people will always be delinquent in getting their animals revaccinated. It seems to me that the current rules take human nature into account.

My question is - What am I missing? I'm sure my argument is probably flawed in some way, but from a lay person's perspective I'm having a hard time with the Banfield/delinquency argument.

Note: I'm anticipating being squashed like a bug by Dr. B, so let me just say in advance - Please be gentle with me Dr. B ; - )

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Msg # 7330

Subject: RE: [TexasVets] More Vaccination is not always better

"Better to remain silent and be thought a fool than to speak out and remove all doubt. " --- Abraham Lincoln

I should know better than to get into a debate with skilled beneficial nematode who may have been formally trained in bamboozlement, but here goes. . . .

<< I think this survey would be much more relevant if Texas' rules currently required annual vaccinations with a one year vaccine and we were considering changing to triennial vaccinations with a three year vaccine.

I think you are trying to glean information from the study that it really doesn't provide. The study was done to answer a question about client compliance, not about immunity in pets. The question was: Does a 3 year rabies vaccination schedule result in inherently less client compliance than a once year rabies vaccination schedule (regardless of whether a one year or a 3 year vaccine is used)? The answer is, "no. " Many Texas Vets have used the argument that they don't want to switch from yearly to triennial vaccines, because they are afraid that making that switch will make clients less likely to come in at all. But the TDH-Banfield study, which assessed HUGE numbers of pets, proves that this is indeed not the case.

Correct me if I am wrong, but it sounds like you want to pose a different question: "Are there more immune pets when a three year vaccine is used triennially or when a three year vaccine is used annually? " The Banfield Study can't be used to answer this question, because if did not assess immunity AT ALL.

<< In either a 1 yr/1 yr state or a 3 yr/3 yr state I assume that a dog that is 6 months late for its revaccination is no more or less protected under either protocol --- in both instances the dog is 6 months beyond the immunity period stated on the bottle.

Not necessarily true. You may have way too much faith in labels. The actual immunity curves produced by the vaccines in laboratory animals are known only to the manufacturer and the USDA (if that data was used to get USDA approval). Unfortunately, manufacturers have no obligation to share that information with us. You are assuming that immunity magically begins to wane as soon as the label recommendations are exceeded--there is no evidence that this is true, and there is some evidence that this is false. One manufacturer released 44 month postvaccination data which showed that
100% of cats were still protected (see the TDH whitepaper).

<< However, by going from a 1 yr/3 yr rule to a 1 yr/1 yr or
3 yr/3 yr (as is the recommendation of Zoonosis Control) there is a real difference.

Not necessarily. One year vaccines are not necessarily inherently less immunogenic than three year vaccines. Vaccines may get approval for one year use first, then be approved for three year use later, when the three year studies are complete. Same vaccine, same long term immunity produced
(more than 3 years), but two different labels. I think Purevax is an example of a one year vaccine that is now undergoing the approval process for triennial use.

<< Therefore, it would seem to me that it would be unscientific to assume that the vaccine lasts any longer than the data has shown.

Not really, based on what we know about immunity. Immunity curves usually rise rather sharply, reach a peak that is sustained for a variable amount of time, and then wane. Those that tend to have longer sustained immunity peaks tend to also wane more slowly. Leptospirosis and Bordetella have relatively short sustained immunity, and wane within a year or so. But a vaccine that has been shown to produce sustained immunity for at least three years is likely to wane over a period that is much longer than that. And in general, immunity after the second and third immunizations lasts much longer than that after the first. So if sustained immunity after the first triennial rabies vaccine lasts at least 3 years, it is likely that sustained immunity after the second and third vaccines lasts even longer.

If you want to stick to your guns that it is unscientific to assume that the vaccine lasts any longer than the data has shown, because there is no data on DOI longer than 3 years ion dogs, then you might have to admit that it is equally as unscientific to assume that immunity wanes at all after 3 years.

<< I would therefore argue that there is a serious difference between those who are delinquent in Texas and those who are delinquent in those states who vaccinate strictly according to the label. We currently have a two year "buffer" in dogs in Texas that will be eliminated if the recommended changes are approved.

The "buffer theory" assumes that immunity to rabies does wane significantly between year 3 and 4, but there really is no evidence that this is true. The single piece of evidence that we have that assesses immunity at more than 36 months post vaccination in fact shows that it is not beginning to wane yet at 44 months.

<< I guess this is really more of a "human nature" argument than a scientific one. I think it is clear that a certain number of people will always be delinquent in getting their animals revaccinated. It seems to me that the current rules take human nature into account.

Exactly. Science shows that triennial vaccination for rabies with a triennial vaccine gives good protection for dogs and cats. Recommending vaccination more often than that for pets whose vaccination history can be confirmed is based on something other than science. And don't forget that while vaccines are in general very safe, they are not completely innocuous. I think you'd be hard pressed to find a vet with a few years of practice experience who has not personally experienced a fatal or other serious adverse vaccine reaction. It's bad enough that it happens, but it's a real bummer to watch this happen when you know darn well that every study you have seen shows that the vaccine that just caused the problem really was not needed.

"Above all, do no harm. . . "

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Msg # 7331

Subject: Rabies vaccinations

Duration of Immunity to Canine Vaccines: What We Know and Don't Know

Ronald D. Schultz, Professor and Chair - Department of Pathobiological Sciences

School of Veterinary Medicine, University of Wisconsin-Madison

It has been common practice since the development of canine vaccines in the late 1950's to administer them annually. The recommendation to vaccinate annually was based on the assumption that immunity would wane in some dogs, thus to ensure immunity in the population, all dogs required revaccination since it was not practical to test each animal for antibody. Little or no research has been done to demonstrate that the practice of annual revaccination has any scientific value in providing greater immunity than would be present if an animal was never revaccinated or was revaccinated at intervals longer than one year.

In 1978 we recommended an ideal vaccination program would be one in which dogs and cats would be revaccinated at one year of age and then every third year thereafter (1). That recommendation was based on a general knowledge of vaccinal immunity, especially the importance of immunologic memory and on duration of protection after natural subclinical or clinical infections as well as on limited studies we had performed with certain canine and feline vaccines. Since the mid 1970's we have done a variety of studies with various canine vaccines to demonstrate their duration of immunity. From our studies it is apparent, at least to me, that the duration of immunity for the four most important canine vaccines (core vaccines) that the duration of immunity is considerably longer than one year. Furthermore, we have found that annual revaccination, with the vaccines that provide long term immunity, provides no demonstrable benefit and may increase the risk for adverse reactions. We have assessed duration of protective immunity primarily by two procedures; the first is held to be the "gold standard and that is to challenge the vaccinated animal with the virulent organism, the second method is to measure antibody and compare the antibody titer to that which is known to prevent infection (e. g. provide sterile immunity). The studies we report here include challenge studies as well as studies that determine antibody titers. A summary of our results show the following (Table 1).

The minimum duration of immunity data does not imply that all vaccinated dogs will be immune for the period of time listed, nor does it suggest that immunity may not last longer (e. g. the life of the dog). The percentage of vaccinated animals protected from clinical disease after challenge with canine distemper virus, canine parvovirus and canine adenovirus in the present study was greater than 95%.

Although there is much more that we need to know about duration of immunity to canine vaccines the information we have at present provides adequate justification for the vaccination recommendations that I and others have made and continue to make regarding frequency of vaccination (2)

1. Schultz, RD. and F. W. Scott. Canine & Feline Immunization. In: Symposium on Practical Immunology. R. D. Schultz, Ed. , Vet Clinics of N. Am. , Nov. 1978, W. B. Saunders Co.

2. Schultz, R. D. Current and Future Canine and feline vaccination programs. Vet Med 3: No. 3, 233-254, 1998.

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Msg # 7333

Subject: RE: [TexasVets] Rabies cases/vaccinations

<<<You may have had a rabid dog in your clinic but I would bet money that it had never been vaccinated a single time. >>>

Scott, You are right. The dog had never been vaccinated. What does the health department say to do with a vaccinated animal that gets bitten by a rabid animal? Seems like the last time I asked their first recommendation was euthanasia. Ken Keil DVM Eastside Animal Hospital Waco Texas

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Msg # 7334

Subject: re: rabies

<<For some reason, we really haven't done much in the way of public education on the need for rabies vaccines--it's probably way past time we do. Just another thing to add to the list of things to do. If we could just get a greater percentage of the pet population vaccinated for rabies even once or twice in their life, I think we would be a lot better off.

I think this is correct-- just an anectodal example of the breakdown in public education: I recently had a dog brought in with several days progression of neurologic signs, fever, neck pain, and some aggression towards other pets (think due to pain)-- I suspect the dog had meningitis, but o could not afford any diagnostics, and because this was a 100# dog that was down and sick, opted to euthanize.

Dog had been vaccinated once as a pup for rabies, was not boosted/"current"
(according to the law a couple months ago), and was kept outdoors. O adamantly refused to allow me to have the dog rabies tested. I advised her that, while I didn't 'think' the dog had rabies, I couldn't promise it. . . gave the spiel about Texas being under rabies quarantine, 100% fatal disease, "want to make sure your family isn't at any risk", etc-- she still insisted on taking the dog home and burying.

I was the only one who had handled the dog around the mouth and am vaccinated and have a very high titer, so I didn't keep fighting her over it and let her take the dog home. But the point is, this woman had ZERO concern about the possibility of rabies, and did not obviously consider it a "real" concern. I really wasn't that worried about it either, but if my kids had been around this dog, I sure as heck would have tested.

Does the public only thing rabies happens in "Old Yeller"? Or is this lack of concern purely a "city-dweller" phenomenon, and do the rural clients "get it"? And, for future reference, what if I HAD thought this dog might really have rabies-- what are we supposed to do when a client refuses a rabies test, and we want to do it because of staff exposure etc? (Haven't had this be an issue yet, so this is a good time to ask. . . . )

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Msg #7337

Subject: RE: [TexasVets] Rabies cases/vaccinations

<< What does the health department say to do with a vaccinated animal that gets bitten by a rabid animal? Seems like the last time I asked their first recommendation was euthanasia.

From the 2002 TDH Rabies Control Document
(http: //www.tdh.state.tx.us/zoonosis/rabies/rpt2002.pdf):

"Any domestic animal that is bitten or scratched by a wild, carnivorous animal or a bat which is not available for testing should be regarded as having been exposed to a rabid animal.

Not currently vaccinated domestic animals that have been bitten or directly exposed by physical contact with a rabid animal or its fresh tissues should immediately be humanely killed. However, if sufficient justification for preserving the animal (for which an approved rabies vaccine is available) exists, the exposed animal should be immediately vaccinated against rabies, placed in strict isolation for 90 days, and given booster vaccinations during the third and eighth week of isolation. For young animals, additional vaccinations may be necessary to ensure that the animal receives at least two doses at or after the age prescribed by the USDA for the vaccine administered.

Currently vaccinated domestic animals (for which an approved rabies vaccine is available) which have been bitten or otherwise significantly exposed to a rabid animal should be humanely killed. However, if sufficient justification for preserving the animal exists, the exposed vaccinated animal should b given a booster rabies vaccination immediately and placed in strict isolation for 45 days.

These periods of strict isolation for domestic animals possibly exposed to the rabies virus should not be confused with the 10-day observation period for a dog, cat or ferret that has bitten or scratched a human, as described in the Post Exposure Prophylaxis Section. A dog, cat or ferret exposed to a rabid animal may develop rabies long after the exposure since the incubation period for rabies can be more than one year. A prolonged isolation and observation period is necessary to exclude the possibility of subsequent rabies in a dog, cat or ferret exposed to a rabid animal. "

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Msg # 7339

Subject: Rabies vaccination

I am curious why no one ever talks about maternal antibody interference with respect to rabies vaccine. Do we have studies to show that maternal antibodies don't interfere with any rabies vaccine? Even if the data supports that 100% of the dogs/cats respond to present vaccines at 12 weeks of age, what about the stray puppy/kitten brought in for shots and gets a rabies but is really only a big 9-10 week old puppy/kitten?

Secondly, I have always wondered why we only give one rabies to puppies/kittens. I doubt that we get 100% protection that way even without considering maternal antibody. What about immunosuppressed individuals? What if they are incubating some disease?

Thirdly, if we indeed switch to a 3 year protocol and vaccinate a puppy/kitten at 12 weeks and a year later, will not a certain percentage of them still have questionable immunity? Would't it be prudent to test them for protective titers at 2 years before we skip to year 4?

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Msg # 7341

Subject: Re: [TexasVets] re: rabies

Does the public only thing rabies happens in "Old Yeller"? Or is this lack of concern purely a "city-dweller" phenomenon, and do the rural clients "get it"?

Celeste, I don't think it is a "city-dweller" thing at all. I am in a town of 11, 000 with 45, 000 in the county as a whole. I get the same attitude. We have a lot of people that hunt feral hogs with dogs. They are rarely vaccinated for anything because their life expectancy is not that great. Who knows what all they come in contact with. My favorite story along these lines is the lady that picked up the seizuring raccoon from the side of the road. Finally, after it bit 3 family members and her husband shot it in the head she decided to call me. BTW, she was an MD.

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Msg#7345

CT, I think the owners have no choice. You do not ask you tell them you will need to get the dog tested. I just had one like that I seizuring unable to move Dalmatian pup with chewing gum fits and trying to bite everything. It is most likely a distemper, but they gave a history of aggression the previous day. Weakness in the back legs then the seizures started this eveing. I was concerned enough that there is not chance I was even going to give this people any options other then testing the dog. I thought by law they have no option.

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Msg # 7346

Subject: Re: [TexasVets] Rabies vaccination

I am curious why no one ever talks about maternal antibody interference with respect to rabies vaccine. Do we have studies to show that maternal antibodies don't interfere with any rabies vaccine? Don Ron Schultz has published that some dogs will have maternal antibodies out to 3 1/2 months. Therefore I think it is prudent to vaccinate as close to 4 months as possible.

The two papers published by Dr Clark in the JAVMA showed approx 8 vacccine failures in Texas. 7 of those dogs had only had one vac at 3 months. Meriels subunit vectored vaccine has been shown effective at 8 weeks in cats and dogs.

Secondly, I have always wondered why we only give one rabies to puppies/kittens. I doubt that we get 100% protection that way even without considering maternal antibody. It was my suggestion to the TDPH that in a county with a rabies outbreak dogs and cats be vaccinated for rabies at 4 and 5 months. This is the recommendation in Alaska. What about immunosuppressed individuals? There are very few immunosupressive conditions that will interfer with the vaccines taking.

See Kirks XIII pg 253. The main problem with immunosupression is reversian to virulence. Hence MLV rabies was removed from the market because Felv infected cats could develope rabies from the vaccine. What if they are incubating some disease? Vaccines are liscenced for the immunization of healthy pets only.

Thirdly, if we indeed switch to a 3 year protocol and vaccinate a puppy/kitten at 12 weeks and a year later, will not a certain percentage of them still have questionable immunity? It has not happened in the 33 states that have 3 yr ordinances.

<< Would't it be prudent to test them for protective titers at 2 years before we skip to year 4? A negative titer does not imply lack of immunity as rabies vaccine produces good cellular immunity, and memmory cells are not measured.

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Msg # 7347

Subject: Re: [TexasVets] re: rabies

----- Original Message -----Sent: Friday, July 26, 2002
8: 53 AM Subject: Re: [TexasVets] re: rabies

<<For some reason, we really haven't done much in the way of public education on the need for rabies vaccines- If we could just get a greater percentage of the pet population vaccinated forrabies even once or twice in their life, I think we would be a lot better off>>

The El Paso VMA used to provide one free book cover to every school child with rabies education on it. The El Paso Health Dept paisd high school kids to go door to door and check on rabies vaccinations. Both were highly effective. Instead of Drug companies buying Vets fajitas and giving sales pitches and calling it CE why not use the money for rabies education?

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Msg # 7356

Subject: rabies reply to drbob

In answer to my question about immunity of a rabies vaccine in an animal "incubating" a disease, you replied that the vaccine is labeled for "healthy" animals only. That is why I said incubating instead of showing clinical signs of disease. We gave a humane society puppy a thorough physical exam, which he passed, and a RV, DHPPC on Monday of this week and on Thursday he broke with parvo. Assuming he recovers, how is his immunity to Rabies?

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Msg # 7356

Subject: More Vaccination is not always better (LONG)

Drs: Well, as I predicted, I took a bit of a beating on that last post, but I'm back for more punishment. Doe anyone remember the movie Cool Hand Luke when Luke fights the much bigger Dragline? Dragline is just beating the tar out of Luke and everyone is telling Luke to stay down to avoid further abuse, but Luke keeps getting back up. Well, I can almost hear some of you out there telling me to "stay down. " ; - )

Dr.WB wrote: "I think you are trying to glean information from the study that it really doesn't provide. The study was done to answer a question about client compliance, not about immunity in pets. The question was: Does a 3 year rabies vaccination schedule result in inherently less client compliance than a once year rabies vaccination schedule (regardless of whether a one year or a 3 year vaccine is used)? The answer is, "no. " Many Texas Vets have used the argument that they don't want to switch from yearly to triennial vaccines, because they are afraid that making that switch will make clients less likely to come in at all. But the TDH-Banfield study, which assessed HUGE numbers of pets, proves that this is indeed not the case.

I agree that the survey was done in order to determine whether delinquency rates are different in one year vs. three year states, but you can often use information for more than one purpose. While the survey does offer some support to the argument that the delinquency rate is about the same in three year states as it is in one year states, I think it also supports my position which is that if Texas changes to a 3 yr vaccination schedule a large number of individuals (approx. 20%) will continue to be delinquent in getting their pets revaccinated. Putting aside the question of whether or not a 1 yr vaccine lasts longer than 1 yr or a 3 yr vaccine lasts longer than 3 yrs for a moment, based solely on actual challenge trials (not on conjecture based upon other vaccines), I think it is logical to say that a dog that is 12 months late for its revaccination stands a better chance of remaining immunized if it originally received a 3 yr vaccine rather than a 1 yr vaccine.

As for the argument that these vaccines last longer than the time stated on the bottle, the white papers states that other than the one study done on cats by Merial, there are no studies on the duration of immunity of rabies vaccine that demonstrate duration of such vaccines used in the U. S. In fact the paper goes on to say that "the scientific consensus is that data are not available to validate protection beyond three years. " I understand that Dr. R and others have referred to testing on other types of vaccine that show a much longer duration than that on the label and even a rabies study showing antibodies to rabies in dogs at seven years. However, I would still argue that TDH should be taking the conservative approach on the rabies issue and should be relying on the USDA challenge trials as the basis for making its decision and not on theory based upon other vaccines. If I'm not mistaken, representatives of TDH have been asked on numerous occasions about allowing animals to be exempted from further rabies vaccinations if the owner can show that the animal has retained a high titer. In every response I heard from the TDH representatives it was always pointed out that we do not know what a sufficient titer is and thus we can not rely on this information. I'm truly out of my element here so this may be a stupid question, but isn't that what was used in Dr. Schultz's study claiming that the vaccine was still good after seven years? If it is, then I don't think that such information should be used by TDH in making its decision.

I'm sure everyone gets tired of the "if your child was bitten. . . " argument, but I really do think it has some merit when trying to determine just how much confidence a person truly has in the duration of a vaccine. I think that for most people it is easier to stand behind a proposition when discussing "theory, " but things tend to change when a "real life" situation is involved. While I realize that as far as TDH is concerned a dog that is vaccinated with a 3 yr vaccine is considered unvaccinated after one year for purposes of deciding what to do in case of a human bite, practically speaking I think most people would not be overly concerned if their child were bitten by a dog that was a year late for revaccination and had been vaccinated with a 3 yr vaccine. However, would you be nearly as comfortable if that dog had been vaccinated with a one year vaccine? It is my understanding that numerous bite cases go unreported every year so I don't think it is too far fetched to believe that there are individuals who have been bitten by dogs or cats but never do anything about it. Again I would ask, is that person at more risk if it is bitten by an animal that was vaccinated 2 years ago with a 3 yr vaccine or with a 1 yr vaccine? How about 3 years ago with a 3 yr vaccine vs. a 1 yr vaccine? I just think it is human nature to become more conservative when discussing a situation that directly affects you.

To summarize my position: TDH's obligation is to protect public health. (A TDH official at one of the meetings made the statement that even if keeping the current rules in place had a detrimental impact on some animals it would do so if TDH was not convinced that changing the rules would protect the public to the same extent or better than the current rules). This is a deadly disease; therefore TDH should err on the side of caution when making any changes to its rules. By its own admission, TDH has stated that "the scientific consensus is that data are not available to validate protection beyond three years. " If that is the case, then it seems to me that TDH should not make any assumptions about duration longer than that listed on the bottle --- to assume any longer duration is to do just that, make assumptions. Finally, if TDH is truly relying upon "the scientific consensus" and is basing its decision on the durations stated on the label, then I think my argument regarding delinquency rates is valid. By going to a rule which basically requires pets to be vaccinated according to the label, we know that approx. 20% of the pets are going to be delinquent and thus be "unvaccinated" for some period of time beyond the stated duration of immunity. Again, just me, but I think the conservative approach would be to keep in place a rule that all but ensures that that 20% is fully protected.

Final Note: I also understand that the bigger problem we are facing is with all of the dogs and cats that are never vaccinated at all. TVMA has agreed to work with TDH and others in investigating a public health campaign to address this issue. This is certainly not going to be easy as the money involved in such a campaign can be overwhelming. The "Shots Across Texas" emphasizing the need for childhood immunization done by TDH several years ago was a multi-million dollar campaign. We don't have the funds available for such a campaign and it is doubtful that the legislature is going to provide much help, but we are going to do our best to address this problem.

Forgive me for running on --- especially if my arguments are full of hot air. I don't want to waste anyone's time responding to my post if I'm completely missing the boat. More than anything I truly want to understand this issue and I'm simply having a hard time understanding how the current rule does not offer at least a minimal amount of extra protection to the public.

Your confused nematode,

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Msg # 7357

Subject: Re: [TexasVets] Rabies cases/vaccinations

Debbie, I have a form I have people sign when they refuse medical treatment but I have never used it in this situation. I should start but it rarely happens that people refuse a rabies vaccination since we changed to charging an exam for all pets. The rabies vaccination is only another $5 and after I explain to them that the animal could be euthanized to be tested if it is unvaccinated they consent. I don't think we are required or legally bound in any way to enforce the law. The owner is responsible. Ignorance of the law is not a defense but is often used these days.

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Msg # 7358

Subject: Re: [TexasVets] More Vaccination is not always better

In a message dated 7/25/2002
7: 01: 36 PM Central Daylight Time, WB writes:

.<<<One year vaccines are not necessarily inherently less immunogenic than three year vaccines. Vaccines may get approval for one year use first, then be approved for three year use later, when the three year studies are complete. Same vaccine, same long term immunity produced (more than 3 years), but two different labels. >>>

Several years ago my Pfizer rep told me that Defensor 1 (the 1 year rabies vaccine) and Defensor 3 (the 3 year rabies vaccine) are exactly the same vaccine with different labels!

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Msg #7359

Subject: Re: [TexasVets] re: rabies

In a message dated 7/25/2002
9: 49: 05 PM Central Daylight Time, CT writes:

<<< what are we supposed to do when a client refuses a rabies test, and we want to do it because of staff exposure etc? >>>

If I thought the client would give me trouble over this I would call animal control (or the Health Dep't) and tell them the situation and let them deal with the owner. The owner doesn't have a choice in this but we can let someone else take the heat.

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Msg # 7362

Subject: Rabies vaccination odds'n ends

This list certainly came to live over rabies vaccinations. Some of the questions may have been answered at the seminar by Merial we had here in Dallas last night. I wouldn't profess to be able to reproduce intelligent comments on the program.

The question of who is responsible for getting the animal vaccinated should remain with the owner. The question of what the veterinarian's responsibility with an unvaccinated animal with CNS signs is a good one. The animal belongs to the owner and we work for the owner but if there is the possibility of human exposure doesn't our community responsibilty kick in. Recently I think I wrote to the list about a veterinarian who was summoned for board action for submitting the head of a stray cat with CNS signs who had bitten an owner and a clinic assistant. What exactly is our responsibility and who or what will back up our decision to actively intervene or to do nothing.

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Msg # 7362

Subject: Re: [TexasVets] rabies reply to drbob

From: "DSC" Subject: [TexasVets] rabies reply to drbob

<<<In answer to my question about immunity of a rabies vaccine in an animal "incubating" a disease, you replied that the vaccine is labeled for "healthy" animals only. That is why I said incubating instead of showing clinical signs of disease. We gave a humane society puppy a thorough physical exam, which he passed, and a RV, DHPPC on Monday of this week and on Thursday he broke with parvo. Assuming he recovers, how is his immunity to Rabies? >>>

Dr DSC , I dont know the answer to that question. I will be glad to pass it on to Dr W on Vin and get back to you. I would revaccinate the dog for Rabies and distemper.

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Msg # 7365

Subject: RE: [TexasVets] More Vaccination is not always better (LONG)

<< I think it is logical to say that a dog that is 12 months late for its revaccination stands a better chance of remaining immunized if it originally received a 3 yr vaccine rather than a 1yr vaccine.

I don't agree, but I don't have anything to add that I didn't say before. We CAN NOT assume that immunity provided by 3 year vaccines is inherently longer than immunity provided by 1 year vaccines. What is the basis for that assumption?

<< I would still argue that TDH should be taking the conservative approach on the rabies issue and should be relying on the USDA challenge trials as the basis for making its decision and not on theory based upon other vaccines.

I agree. HOWEVER, if TDH bases its recommendations on the DOI studies submittted to the USDA by vaccine manufacturers, they will allow vaccination every three years with triennial vaccines. There is rock solid scientific data that this is effective. I agree that immunity to other diseases has nothing to do with immunity to rabies, and should not be brought into this discussion. Even medical professionals have a tendency to try to make extrapolations among different vaccines, diseases, species and vaccines, and it really isn't appropriate. Each particular vaccine produces a particular immune response to a particular disease, which may be unique in each species.

<< but things tend to change when a "real life" situation is involved.

Rabies is much more of a real life situation to every practicing veterinarian than it is to any lawyer [ ; -) ]. I've been exposed to several unvaccinated dogs who died having seizures--believe me, I've been there. Interestingly enough, MD's thought my titer was sufficient to forgo post exposure prophylaxis while waiting for rabies test results, despite there being no challenge studies to confirm what a protective titer is in humans
(as if THAT would ever happen. . . ).

<< Again I would ask, is that person at more risk if it is bitten by an animal that was vaccinated 2 years ago with a 3 yr vaccine or with a 1 yr vaccine? How about 3 years ago with a 3 yr vaccine vs. a 1 yr vaccine?

These questions are academic, and posing them and trying to guess the "logical answer" really does us little good, because the answers are not known, and likely will never be known. 1 year vaccines should NOT be assumed to in any way to be equivalent to one another, nor should 3 year vaccines. Each vaccine is unique, and receives the label for the approval process that its manufacturer chooses to complete. Vaccine companies are not motivated to release information that might show that their vaccines last longer than the label indicates (sales would go nowhere but down) and I doubt very much that many private investigators would be willing to work with virulent rabies virus.

<< TDH's obligation is to protect public health.

That's right. It DOES NOT (! ! ! ! ! ! ! ) further protect anyone or anything to re-vaccinate an already immune pet. Requiring use of a vaccine more often than is indicated by the data, and ASSUMING that requiring such will manipulate some people into not letting their pet's vaccines lapse is an ASSUMPTION, which Chris said we were not supposed to make.

<< This is a deadly disease; therefore TDH should err on the side of caution when making any changes to its rules.

Vaccines can also be deadly, and in my clinical experience, death from vaccines is MUCH more common than death from rabies. I would bet that if we counted the deaths from vaccines which vets on this list have experienced, the total would be in the hundreds. I would also guess that if we counted the number of cases of rabies in domestic animals experienced by the vets on this list, the number would be less than I could count on my fingers. I am not trying to minimize the importance of rabies control--it is a deadly disease that of course needs to be controlled. But what should we do when our preventative measure becomes so effective that it becomes more deadly than the disease itself? Is it then appropriate to ease up on the preventative measure, especially when there is no doubt that we are using it at least three times more than is necessary?

<< to assume any longer duration is to do just that, make assumptions.

ASSUMPTION WARNING #1: There is a big difference between making a blind assumption, and making a very educated guess based on what we know about disease and immunity. Veterinary medicine is more educated guess than science any day of the week.

<< Finally, if TDH is truly relying upon "the scientific consensus" and is basing its decision on the durations stated on the label, then I think my argument regarding delinquency rates is valid.

It may be valid from the perspective of a legislator whose primary purpose is to protect the human world from rabies at all canine and feline costs and consider little else. But it is not valid from my perspective, as a veterinarian who is required by law to administer a likely safe, but potentially harmful (even fatal) substance to my patient, when there is very little doubt that my patient will receive little or no benefit. The chance of death from vaccine is very small, but if it happens to your pet, it is
100% for you, and it matters little how rarely it happens.

<< a rule which basically requires pets to be vaccinated according to the label, we know that approx. 20% of the pets are going to be delinquent and thus be "unvaccinated" for some period of time beyond the stated duration of immunity. Again, just me, but I think the conservative approach would be to keep in place a rule that all but ensures that that 20% is fully protected.

From my perspective, especially under the current law, being legally unvaccinated has nothing to do with having poor immunity to rabies. That's a real shame. ASSUMPTION WARNING #2: I'll bet you my Blazer that a vast majority of dogs and cats are still protected from rabies 6 months after the label recommendations have been exceeded.

<< Final Note: I also understand that the bigger problem we are facing is with all of the dogs and cats that are never vaccinated at all.

In my opinion, WAY BIGGER! ! ! ASSUMPTION WARNING #3: I really believe that the absolute number of pets who might be better protected under the current law than the proposed law is very small, and probably insignificant when compared to the number of dogs and cats in this state who are not vaccinated AT ALL. I think we are barking up the wrong tree.

WB (I'm too tired to attach my signature--hope everyone can forgive)

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Msg # 7366

Subject: Re: [TexasVets] rabies reply to drbob

>My point is that we many need to rethink our beginning protocol for rabies vaccine if we switch to a 3 year protocol. I am not sure I am >ready to skip from year one (with one vaccine at 12 weeks and one vaccine at >1 year) to year 4. There are just too many variables on the "individual".

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Msg # 7370

Subject: Re: More Vaccination is not always better

I wonder if Rabies vaccination compliance might actually go UP if people knew they were getting 3 years worh of protection? A better buy for the money, so to speak. If this hypothesis is correct, then we as a profession might actually use 3 yr guidelines as a successful selling point to get the notion of Rabies vaccinations out to a wider population. Rather than revaccinating the same population over and over?

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Msg # 7371

Subject: RE: [TexasVets] rabies reply to drbob

<< My point is that we many need to rethink our beginning protocol for rabies vaccine if we switch to a 3 year protocol. I am not sure I am ready to skip from year one (with one vaccine at 12 weeks and one vaccine at 1 year) to year 4. There are just too many variables on the "individual". >>

I agree that vaccination early in life is the most important. Many have advocated giving rabies as a pup, then again at both 1 year and 2 years of age before going to every three years. If the new rules are adopted, I think you should be able to do this if you wish.

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Msg # 7385

Subject: Re: [TexasVets] Rabies cases/vaccinations

My first year in practice we sent out the head on a dog that had suddenly become very aggressive and bitten the owner (owners request). He had been vaccinated every year at a "rabies clinic"--not ours, thankfully! He was rabies positive! Shocked me at the time! It was in Pearsall, which as some of you know is very hot. Wondered if the vaccine clinics were using 10 ml vials of vaccine and not keeping them cold between drawing up

vaccinations--but three years in a row? I know the vaccine is very good and this kind of thing is rare but it did happen, so it probably could again. L

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Msg # 7386

Subject: Rabies

L's case reminded me of something I've wanted to post on the subject. Even if the vaccine was good, that was a dog that probably wasn't going to get immunized. Back to my topic. For this I will put on my old public health hat. Dr. Mahlow & others actively involved in public health might say this better, but I think I remember enough to not be off base. As practitioners we seem to have a hard time separating sylvatic rabies (terrestrial & bats) from dog rabies and their impacts on human health.

Most of the older group of us were taught rabies is rabies is rabies. Eventually, I figured out bat rabies was different from terrestrial rabies. Finally (I hope finally), I've discovered that rabies is fairly species specific as far as maintaining in nature & passing thru species. For example, bat rabies is highly virulent to almost any mammal bitten by a bat. However, that mammal isn't likely to pass it on or maintain it in its own species.

That is why a number of years ago, public health officers started talking about terrestrial rabies. Bat rabies just doesn't maintain outside of bats. We've later learned that this is true of most of our rabies epizootics that have resulted in enzootic rabies in a number of wild species. That is why the Southeast has raccoon rabies & we don't. Our raccoons get rabies from our skunks, foxes, coyotes, & bats, but they don't maintain it & have raccoon rabies.

My point is that humans or other species are unlikely to get rabies from a dog or cat that got rabies from a bat, skunk, or fox. We certainly aren't likely to get rabies from livestock that are positive. I don't know if there are any proven cases where a dog or cat infected another animal or a human with rabies of another strain. It is certainly possible in theory if that animal has virus in its saliva. Where we humans are likely to get rabies is from a bat, skunk, fox, coyote, raccoon, etc. with its own adapted strain.

AND, we are likely to get it from a dog with Mexican dog/coyote strain rabies which is a dog strain adapted to coyotes. Dogs & coyotes pass this back & forth among themselves & infect anything else they bite. That is why the South Texas scenario was so inherently dangerous. Fortunately, either through the air drop oral vaccination program or possibly through a natural cycle, that situation has waned. This leads me the issue of vaccination frequency & why Texas is not different from other places. The liklihood of a pet passing rabies on to a human is pretty miniscule in the absence of dog strain rabies in a dog.

The issue of vaccination is herd immunity to prevent an outbreak that might be adapted to a domestic species (realistically this is probably only dog/coyote strain in dogs). We need to adequately vaccinate a large percentage of the susceptible population. This is particularly a problem in South Texas that gets worse as you go south.

That is why the last outbreak almost got away from the authorities. Now don't get me wrong! If I'm bitten by a rabid cat or am involved with a human that is, the smart, conservative thing to do is get treated. I firmly believe that we need to adequately vaccinate all our pets for which there is approved vaccine, we need to control stray animals, & we need to actively assure vaccination in areas at risk even if it means state funding.

These are measures that will help control rabies. More frequent vaccination of a small percentage of the population does not. The other thing we must do is continue to educate people about the rabies that we cannot control in bats & wild terrestrial mammals. This is to make sure people don't handle these animals. They need to understand that the animal they can touch probably isn't well & could have rabies.

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Msg # 7427

Subject: Re: annual vaccination controversy

Here is an article from today's Wall Street Journal: Some Vets Rethink the Need For Annual Pet Vaccinations By RHONDA L. RUNDLE Staff Reporter of THE WALL STREET JOURNAL

After receiving a reminder in the mail from his veterinarian, Jim Schwartz took his 11-year-old poodle, Moolah, for her annual rabies shot. A few weeks later she fell ill and was diagnosed with an autoimmune disease. As her suffering worsened, Mr. Schwartz put her down. There's no proof that the rabies shot killed Moolah and Mr. Schwartz didn't immediately suspect any link. But when the retired financial planner learned that some veterinarians are vaccinating pets less frequently because of possible fatal side effects, he was furious. "No dog should have to go through what Moolah did, " he says.

Evidence is building that annual vaccination of dogs and cats -- performed for diseases such as rabies, distemper and parvovirus -- may not be necessary and could even be harmful. Vaccines licensed by the U. S. Department of Agriculture are tested to ensure they protect pets against disease, usually for one year. But the tests don't detect long-term side effects, or measure the duration of a vaccine's effectiveness. Recent and continuing studies at several universities suggest that protection from vaccines may last for years, which would make annual shots for some diseases a waste of money -- at the very least.

Fears of vaccine-induced diseases date back more than 40 years. But a sharp increase during the past decade in cancerous tumors among cats, between the shoulder blades where vaccines typically are injected, has spurred studies. Some have found a higher-than-expected incidence of side effects. "We see health problems in dogs for which we have no explanation. The classic one is autoimmune disease, " says Larry Glickman, professor of epidemiology at Purdue University's School of Veterinary Medicine in West Lafayette, Ind. , who is studying possible links with vaccinations. "We see an epidemic of hyperthyroidism in cats today, and we suspect that these are happening because we're over-vaccinating our pets. "

Dr. Glickman and his colleagues theorize that repeated vaccination causes dogs to produce antibodies against their own tissue. The antibodies are caused by contaminants in the vaccine introduced in the manufacturing process. While the amounts are minuscule, they gradually accumulate with repeated vaccinations over the years. But Dr. Glickman cautions that more research is needed before a clear link can be established between antibody levels and autoimmune disease.

Vaccination recommendations for cats and dogs vary around the country. Most states require rabies vaccinations every three years, while a handful of states -- as well as some individual cities and counties -- have mandated annual shots due to llocal problems with rabies in wild animals. Some other vaccinations are given only when a pet's lifestyle or environment exposes it to a particular risk, such as Lyme disease. Pet diseases other than rabies aren't a threat to people, thus vaccinations aren't required by law.

But veterinarians and vaccine makers have traditionally recommended annual booster shots against potentially fatal diseases such as distemper and parvovirus in dogs and herpesvirus in cats. In a policy statement last year, the American Veterinary Medical Association acknowledged that the practice of annual vaccinations is based on "historical precedent" and "not on scientific data. " The emerging evidence of health risks is prompting some vets to change their practices.

"We're now doing 40% less vaccinations than five years ago, " says Kathleen Neuhoff, a veterinarian in Mishawaka, Ind. , and president of the American Animal Hospital Association, Lakewood, Colo. "My own pets are vaccinated once or twice as pups and kittens, then never again except for rabies, " Ronald D. Schultz, chairman of the University of Wisconsin's Department of Pathobiological Sciences, wrote in the March 1998 issue of Veterinary Medicine.

Some critics of annual shots accuse some vets of ignoring research about vaccine risks for financial reasons. "Vets are afraid they will go broke" without regular vaccines, which account for about 20% of their practice income, says Bob Rogers, a Spring, Texas, veterinarian and outspoken critic of current practices. Other vets deny that financial motives are involved. ("No one who is motivated by money would ever become a veterinarian, " Dr. Neuhoff says. ) "

The concern is that if we move too quickly to decrease vaccine frequency across the board, we may be opening the door for some animals to become infected when we could have prevented the problem, " says Todd R. Tams, chief medical officer of VCA Antech Inc. , in Los Angeles, the nation's largest owner of veterinary hospitals.

No one truly knows how long protection from vaccines lasts. Vaccine makers say that proving their duration would be expensive and would require large numbers of animals to be isolated for years. One company (Pfzier) decided to test its one-year rabies vaccine on live animals and discovered it lasted for at least three years. It sells the identical formula simply packaged under different labels -- Defensor 1 and Defensor 3 -- to satisfy different state vaccination requirements.

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Msg # 7531

Subject: RE: TVMA position statement on rabies vaccination proposal from TDH

<< Rabies serovars endemic to Texas are very unlikely to be transmitted to people from pets who might be infected, even if they are not vaccinated at all I based this statement on the information from Dr. C's post, which I quote below: "I've discovered that rabies is fairly species specific as far as maintaining in nature & passing thru species. For example, bat rabies is highly virulent to almost any mammal bitten by a bat. However, that mammal isn't likely to pass it on or maintain it in its own species. . .

This leads me the issue of vaccination frequency & why Texas is not different from other places. The likelihood of a pet passing rabies on to a human is pretty miniscule in the absence of dog strain rabies in a dog. The issue of vaccination is herd immunity to prevent an outbreak that might be adapted to a domestic species (realistically this is probably only dog/coyote strain in dogs).

We need to adequately vaccinate a large percentage of the susceptible population. This is particularly a problem in South Texas that gets worse as you go south. That is why the last outbreak almost got away from the authorities. "

However, Greene's Infectious Disease neither supports nor refutes the above statement. Greene confirms the idea that while all warm blooded animals are susceptible, rabies virus in a given enzootic area is a distinct variant that usually adapts itself to a single dominant reservoir host, that in most of the Northern Hemisphere rabies is predominantly a disease of wildlife, and that these wild animals serve as maintenance hosts for virus transmission to dogs, cats, cattle and horses.

However, Greene makes no comment on whether transmission by dogs and cats who carry a wildlife serovar are more or less likely to transmit that virus to people. I honestly don't know if there has ever been a documented case of transmission of rabies by an animals who was infected by a serovar belonging to another species. I looked for some time for more information on this issue, but just couldn't find anything.

Maybe people from TDH could help with this question. For what it's worth, here is an anecdote: Charlie Hall at TAMU was bitten by a kitten in Snook, confirmed to be rabid on examination of its brain tissue. He never took PEP, because the test results were available more than 72 hours after he was bitten, or perhaps for other reasons that you would have to ask him about. He indeed did develop shooting pains in his trigeminal nerve for a little while, but did not develop rabies.

<< So why vaccinate at all To protect pets from a deadly disease, and to afford some small amount of protection to their owners.

I AM NOT arguing against the importance of rabies vaccination--I think it is exceedingly important. I am simply arguing against overvaccination. << why give PEP to people exposed to rabid animals/pets I'm not sure that routine vaccination can be compared to PEP. They are two different animals. If PEP is being considered, then the risk is exponentially higher. Rabid wildlife is a completely different case than rabid pets.

Rabid wildlife IS very likely to transmit a rabies serovar for which it is a reservoir to any warm blooded animal, including pets and people, so rabies PEP is especially crucial for these cases. PEP is given to people who have been exposed to rabid pets for reasons determined by TDH. Since I am not a human MD, I really am not well versed with the risk-benefit assessment here--you'd have to take this question up with TDH.

I am not sure if initial tests elucidate the serovar. If canine serovar can not be ruled out in a dog brain positive for rabies prior to the 72 hour window within which PEP must be started, I would think it would be prudent to go ahead with PEP.

<< why send heads to Austin for testing? I think we all realize the importance of sending heads of wildlife with neurologic disease or who have had contact with people or pets to Austin, because of the high risk of transmission of rabies to pets and people.

And I think we are justified in sending the heads of unvaccinated dogs and cats with neurologic disease or exposure to wildlife to Austin. There is a small risk of this pet passing rabies to a person, but still a risk that I think outweighs by far the risk of letting human rabies go untreated, especially considering the high efficacy of human PEP.

Human PEP hardly ever fails. Those people who die of rabies are usually those who do not receive PEP prior to development of neurologic signs. However, I think it is absolutely ridiculous to kill an asymptomatic dog or cat and send it's head to Austin, simply because it has bitten a person, if it has no known exposure to rabies, and has been vaccinated for rabies with a triennial vaccine within the past three years.

If the pet has been exposed to wildlife that is confirmed to be rabid, then I think we have a tough decision to make, even if the pet has been vaccinated according to the label. Though they are rare, vaccine failures do happen.

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Msg # 7430

Subject: Re: [TexasVets] Re: annual vaccination controversy

I have never heard of this (hypothyroidism connected with vaccination) either. Perhaps they meant dogs with the potential for autoimmune thyroiditis (even though that is a more genetic tendency) creating hypothyroid states. I have 4 old cats that have been indoors all their life and have recieved very few vaccines the last 12 years of their life. 3 of them were occult hyperthyroid on scans. I would be suspicious about this comment until there is proof of such data.

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Msg # 7443

Subject: Re: [TexasVets] Re: annual vaccination controversy

Graham, Peter, Relationships Between infections and vaccinations and the development of immune mediated thyroid disfunction, Proceedings of ACVIM Forum, May 29 2002, pg 143.

A temporal association, dogs vaccinated for rabies annually had a higher incidence of hypothyroidism than dogs vaccinated every three years, dogs receiving frequent intranasal Bordetella had a higher incidence of hypothyroidism.

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Message 7456 of 7782 Previous Next [ Up Thread ] Message Index

Msg # 7456

Subject: Re: [TexasVets] Re: annual vaccination controversy

In a message dated 8/1/2002
10: 04: 38 AM Central Daylight Time, drbob writes:

<<<Graham, Peter, Relationships Between infections and vaccinations and the development of immune mediated thyroid disfunction, Proceedings of ACVIM Forum, May 29 2002, pg 143.

Yes, And all of these patients could equally likely have been diagnosed with Hypothyroidism and Feline Hyperthyroidism because as they were receiving their "life altering". . . ( see also under category {poison}. . . ) vaccine they were seen annually and an accurate physical exam by a money grubbing veterinarian prompted them to run additional bloodwork. Not because they are good doctors, but because they can Charge , Charge , Charge for that blood work. ! ! ! ! How about the temporal relationship that these animals receiving vaccines are better cared for and are more likely to be diagnosed with other ailments ?

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Msg # 7481

Subject: RE: [TexasVets] Re: annual vaccination controversy

<< Yes, And all of these patients could equally likely have been diagnosed with Hypothyroidism and Feline Hyperthyroidism because as they were receiving their "life altering". . . ( see also under category {poison}. . . ) vaccine they were seen annually and an accurate physical exam by a money grubbing veterinarian prompted them to run additional bloodwork. Not because they are good doctors, but because they can Charge , Charge , Charge for that blood work. ! ! ! ! How about the temporal relationship that these animals receiving vaccines are better cared for and are more likely to be diagnosed with other ailments ? >>>

I agree with "the wormer" that temporal association with vaccination of diagnosis of chronic diseases that often go on for months or even years prior to diagnosis is much less relevant than temporal association with vaccinations of acute, life threatening diseases such as IMHA.

I would hope that any temporal association made between vaccination and disease would only be applied to diseases for which there were NO CLINICAL SIGNS at the time of the annual visit, then clinical signs became apparent within a few weeks or months AFTER vaccination. If there were no signs of hypothyroidism at the time of vaccination, and then they developed within weeks to a few months after vaccination, at a much higher rate than unvaccinated dogs, then we have something.

Dr. B's comment about hypothyroidism occurring at a higher rate in dogs vaccinated annually for rabies than those vaccinated triennially really is different from temporal association--his comment suggests some sort of relationship between increased frequency of vaccination and occurrence of immune mediated hypothyroidism. Would love to see the abstract if anyone has it.

I have never heard of an association between feline hyperthryoidism and vaccination.

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Msg # 7484

Subject: Re: [TexasVets] Re: vaccine/ hyperthyroidism

In a message dated 8/3/02
11: 09: 17 AM Pacific Daylight Time, DB writes:

<<<I have never heard of an association between feline hyperthryoidism and vaccination. >>

I question the association, but suspect it is related to the observation that feline hyperthyroidism is extremely rare in Europe, but fairly ordinary here. For a time, diet was implicated, but apparently someone thought it was something to stick under the overvaccination catagory. I am not saying it is either right or wrong, but the epididimology implies that we are doing something different than Europeans. Maybe just diagnosing hyperthyroidism better? ? I don't know the quality of the original information regarding hyperthyroidism here and in Europe. I remember this tidbit from school, years ago and don't know if it was truelly valid then or now.

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Msg # 7501

Subject: TVMA position statement on rabies vaccination proposal from TDH

Fellow veterinarians: The following is the official position statement from the TVMA Board of Directors which was passed at out meeting on 3 February. This statement was issued in response to the forthcoming recommendation from the Zoonosis Control Division to the Texas Board of Health. The recommendation will state that dogs and cats be vaccinated against rabies by 4 months of age, boosted a year later, and then boosted at least every third year.

TVMA SUPPORTS CONTINUATION OF THE CURRENT TEXAS DEPARTMENT OF HEALTH REQUIREMENTS FOR ANNUAL RE-VACCINATION OF DOGS AND CATS AGAINST RABIES. UNTIL MORE SCIENTIFIC RESEARCH INDICATES A BENEFIT TO THE PUBLIC HEALTH BY CHANGING THE CURRENT REQUIREMENTS,

TVMA FEELS THAT ANY RELAXATION OF THE STANDARDS FOR RABIES VACCINATION COULD ENDANGER THE HEALTH AND SAFETY OF THE CITIZENS OF THE STATE OF TEXAS.

FURTHERMORE, TVMA JOINS WITH THE TDH IN CALLING FOR THE PROMOTION OF VACCINATION OF EVEN MORE ANIMALS AGAINST RABIES AND FOR MORE RESEARCH ON THE RE-VACCINATION SUBJECT.

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Msg # 7506

Subject: RE: TVMA position statement on rabies vaccination proposal from TDH

<< TVMA SUPPORTS CONTINUATION OF THE CURRENT TEXAS DEPARTMENT OF HEALTH REQUIREMENTS FOR ANNUAL RE-VACCINATION OF DOGS AND CATS AGAINST RABIES. UNTIL MORE SCIENTIFIC RESEARCH INDICATES A BENEFIT TO THE PUBLIC HEALTH BY CHANGING THE CURRENT REQUIREMENTS, TVMA FEELS THAT ANY RELAXATION OF THE STANDARDS FOR RABIES VACCINATION COULD ENDANGER THE HEALTH AND SAFETY OF THE CITIZENS OF THE STATE OF TEXAS. FURTHERMORE, TVMA JOINS WITH THE TDH IN CALLING FOR THE PROMOTION OF VACCINATION OF EVEN MORE ANIMALS AGAINST RABIES AND FOR MORE RESEARCH ON THE RE-VACCINATION SUBJECT. >>

Can anyone explain to me how vaccination according to label recommendations endangers anyone? ? ? Since when is following the manufacturer's instructions a "relaxation" of anything? ? ? It is TEXAS who artificially decreased the required vaccination interval, and NOT based on any scientific data. How is it a "relaxation" to reverse a decision which was questionable in the first place?

I have yet to see a single piece of data which supports decreasing the vaccination interval from label recommendations. Yet I have seen dozens of citations (and have shared all of them with this list) which support vaccination according to the label, or even more conservatively. TVMA, where is the data that supports YOUR decision? ? ? ? ? I suspect it is based on emotion and anecdote, rather than science.

1. One argument has been that more owners will be compliant if they are required to vaccinate more frequently, but the Banfield-TDH study on MILLIONS of pets shows this not to be true.

2. Another argument is that more vaccination will increase immunity in each individual pet, but there is no evidence that this is true. In fact, the HogenEsch study showed that when compared to yearly triennial vaccination, yearly vaccination did not increase protective antibodies (IgA, IgM, IgG), only IgE, which might indicate increased likelihood of immune mediated adverse reaction. This study suggests increased risk with no increased benefit. I this really the intelligent thing to do?

3. Another argument is that vaccinating pets more often may increase herd immunity in pets. However, herd immunity does not apply to pets and rabies, except for potentially in areas that border Mexico and might be at risk for the canine serovar. Continuing over-vaccination in areas at risk for endemic canine serovar is reasonable, but NOT in areas a thousand miles from there, with the entire Gulf of Mexico between them and Mexico
(i. e. , like where I live).

4. Research will NEVER indicate a benefit to public health of switching from annual to triennial vaccines. Why would TVMA wait for this? ? We are vaccinating pets, not people, and not wildlife. Rabies outbreaks are controlled by eliminating or immunizing reservoirs, and pets are not in general reservoirs of rabies in Texas. So immunizing pets in Texas will likely have little affect on outbreaks, as has been evidenced by increased rabies in wildlife in Texas, despite overvaccination of pets for many years. Switzerland eliminated rabies from their country after 30 years of endemic disease by an oral wildlife immunization program--not by immunizing pets. As Dr. Carter pointed out, the risk of a person contracting a wildlife serovar rabies from a pet is minimal, even if the pet is unvaccinated.

If there are any other better arguments to support the TVMA position, I would really like to consider them. Let me hear from you.

What is wrong and dangerous about allowing veterinarians in the state of Texas to use a USDA approved biologic according to the label, as is allowed in most of the rest of the world?

You have seen the mountains of data to support my position (I'll send it again to anyone who wants to see it). So here is my challenge. . . . . Where is the data to support the TVMA position?

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Msg # 7507

Subject: Re: [TexasVets] TVMA position statement on rabies vaccination proposal from TDH

<<<<TVMA position statement on rabies vaccination proposal from TDH >>>

Dr Cox, Please explain to me how vaccinating dogs and cats that are already immune to rabies with a vaccine that has been scientifically shown to have no effect helps to protect the public against rabies. **

Hogenesch, Dunham, Scott, Glickman, Deboer, Am J Vet Research 63, April 2002, Effect of Vaccination on serum concentrations of total and antigen specific immunoglobulins E in Dogs.

Please explain to me why the TVMA chooses to ignore the scientific data and make uninformend decessions.

Mabey that is why the TDPH did not listen to the input from the TVMA.

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Msg # 7518

Subject: Re: TVMA position statement on rabies vaccination proposal from TDH

WB, While your data is correct, it is TVMA's position that this is a perception issue on the part of the pet owners. What TVMA is afraid of is that the perception that switching from a one to three year protocol will give the general public the perception that rabies is no longer a problem in Texas. . . . : ) . . . I know that this is not based on data, but we are currently seeing a rise in rabies reports both in wild and domestic animals. Yes, true, these are unvaccinated critters , but it is likely that switching to this program will give the public 2 possible false impressions. . .

1. That we are of the opinion that rabies is on the wane in Texas, and 2. that we believe that all vacccines have a high probability of inducing disease and death. The Texas Dept. of Health has recently asked TVMA to participate in a joint effort to get out the pet owning population to vaccinate their pets to guard against rabies, and from there to follow their doctors advice on how to follow up with future vaccines. This is where your data is correct and should influence active intelligent Veterinarians to synthesize your data so thoughtfully collected and apply it to their demographic and topographic locale.

TVMA's position looks at what is likely to be the outcome of taking the scientific stance vs. the big picture of falsely imprinting in the less responsible pet owner that its okay to not vaccinate since the state is backing off of its recommendation at this time. TVMA's position is not to be based on the science, that is a different issue that we hoped will be addressed once the owner is responsible enough to do the right thing and get into the Vets office. It is a concern that in the face of increasing reports of both Domestic and Sylvatic rabies currently in the state, that while the once yearly vaccine may produce the 0. 8 in 10, 000 cases of adverse reactions that the journal articles pointed out, it is a small price to pay for the prevention of one child getting rabies because of the wrong impression being given by TVMA if it were to support the three year adjustment.

Remembering what that old footage in vet school of the child with rabies was going thru, it is my personal opinion as a parent that its worth the risk of causing the 1 in 12, 000 problems. I can greatly reduce that incidence myself by modifying my protocols with my regular clients, thanks to you sorting thru the data and showing me the light. I mean this in all sincerity. I have changed my opinion based on yours and others posts. Something that could not have occurred three years ago.

Thanks to you "puter " geeks for this truly remarkable exchange. Wendy, your posts, Tom and Dave, Norm and Craig, Steve, all of you guys who have made the collaborative effort to make this all happen have given us a new tool that is more valuable than any text that we could pull down off of the shelf . Its thru the spirit of teamwork that this has been born.

And now TVMA aska for your support in a united front for allowing us to shape the big picture for rabies prevention from a statewide perspective, not a test tube one. You are right Wendy, we are likely to cause some reactions, but this is a choice not based solely on facts and data, but also based on the human equation.

We hope that you will bear with us while we attempt to educate the public and get them current, hopefully in as well thought out a way as you have educated us on the potential problems of over-vaccination. Thank you for your patience. Sincerely,

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Msg # 7521

Subject: RE: TVMA position statement on rabies vaccination proposal from TDH

<< That question was, " Is there evidence indicating that public health will be improved by changing to the new TDH proposal? "

I gathered that was the primary question from the TVMA position statement when I read it. But I don't think it's a rational question upon which to base policy--I think there are other important questions which remain unaddressed. How can you hope to increase protection Public Health by pet vaccination beyond using vaccines according to the label? I think there should be at least 2 more questions: Will the public be less protected by decreasing rabies vaccination requirements from overvaccination to vaccination according to the label? Will risk of pet vaccinosis which is potentially life threatening be decreased by using vaccines according to the label rather than at an increased frequency which is arbitrary? The scientific data answers "no" to the first question and "yes" to the second. It's my opinion that disregarding the answers to these two additional questions is less than prudent.

<<. . . the answer to that question was no, hence the decision to stick with the proven method.

But annual vaccination with a triennial vaccine is NOT proven to prevent rabies outbreaks, nor to increase protection of the public when compared to use of vaccines according to the label. I don't know of any scientific data to support such a policy, and there is certainly no practical experience that supports it. Cases of rabies in wildlife have about doubled ion Texas over the past decade, so risk of exposure to rabies has at least doubled despite this "proven" method. So why do you call the method "proven"?

<< In the case of Rabies, we vaccinate for the well-being of people, not for pets.

Based on what we know about rabies, this is probably not rational. The protection afforded to the pet is most certainly exponentially more medically significant than protection of the people who are exposed to that pet. Rabies serovars endemic to Texas are very unlikely to be transmitted to people from pets who might be infected, even if they are not vaccinated at all. Vaccination of pets according to label recommendation probably affords maximum protection of the public, and is not likely increased by arbitrarily increasing the vaccination interval. Such a policy might be rational where the canine serovar is endemic, but not elsewhere.

<< please stop accusing those who made the decision of using "emotion", "anecdote" or finances to make that decision.

As soon as you provide me with the medical data upon which you base your medical decision, I would be happy to do so immediately.

<< "Emotion" - we are not the ones SHOUTING.

I don't remember shouting, getting angry, or otherwise getting upset. I simply posted a dissenting medical opinion, for whatever it is worth. I don't think there is nothing wrong with being passionate about your beliefs--passion can produce motivation, which can achieve results. I would guess that we have both experienced this. But I would be careful about making medical decision based predominantly on something other than medical information (scientific data, clinical experience, etc. ). Feel free to substitute the another more pleasing word which connotes "based on something other than medical data" for "emotion" and "anecdote" if it ruffles your feathers any less.

<< "Anecdote" - unworthy of response.

Now THEM is fightin' words ; -) !

<< Finances - if that was our motive, we would not give thousands of free hours away from our practices to seek ways to improve this profession.

I never mentioned this in my reply to the TVMA position statement.

No one is criticizing any TVMA members, nor questioning their motives, nor saying that they are anything but wonderful people who spend a great deal of time doing their best to make it better for our profession. We are just expressing that we don't agree with the outcome of this particular policy. This should come as no surprise to you. I have spent hundred of hours collecting and posting information on this subject to this list (also at no compensation, by the way). I would argue that both Dr. B and I also donate thousands of hours of our own time in an attempt to to help our profession--we just choose to do it in a different way than through TVMA.

Based on the discussions which have taken place on this list by the many veterinarians who are concerned about how best to financially transition from annual to less frequent vaccines for other diseases, I would say that there likely is a financial concern here, as there should be. Nothing wrong with being concerned about your finances--we all are. Wish we didn't have to be, but I think it's just part of life that most can't very effectively ignore.

<< This and the many other issues affecting your profession, that TVMA leadership struggles with, requires an enormous amount of effort and energy, and decisions such as this Rabies Position Statement are never taken lightly.

Of course it does. I never implied, nor even thought for a second that it was taken lightly--only that I do not agree with the outcome.

<< I have been in some form of service to this profession for over 30 years and am always amazed at how those who are watching can decide how I and others that are in the "arena" think when making decisions.

I suppose that you regard me and Dr. B as being among "those who are watching. " You might be surprised to know the total number of hours that both Dr. B and I spend "in some sort of service to this profession" (at no compensation to us). We just choose to serve our profession in ways other than through the TVMA. There are many ways to serve.

<< we might all live in a better country if we didn't feel the need to psychoanalyze every decision and every decision maker.

I haven't psychoanalyzed any decisions, nor any of those who made the decision, nor do I have any interest in doing so.

I have one basic question, which remains unanswered, and you will no doubt continue to hear from me until the question is answered. Here it is:

Where is the medical data upon which this medical decision is based?

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Msg # 7525

Subject: Re: TVMA position statement on rabies vaccination proposal from TDH

<< Rabies serovars endemic to Texas are very unlikely to be transmitted to people from pets who might be infected, even if they are not vaccinated at all. >>>

So why vaccinate at all, why give PEP to people exposed to rabid animals/pets, why send heads to Austin for testing?

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Msg # 7526

Subject: Re: TVMA position statement on rabies vaccination proposal from TDH

<<<< Rabies serovars endemic to Texas are very unlikely to be transmitted to people from pets who might be infected, even if they are not vaccinated at all. >>>>

<<< So why vaccinate at all, why give PEP to people exposed to rabid animals/pets, why send heads to Austin for testing? >>>>

One further, what is the incidence of human reaction and/or adverse events with the current rabies post exposure protocol? What is the acceptable risk in human treatment if in fact the risks of rabies disease is so minimal?

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Msg # 7527

Subject: RE: TVMA position statement on rabies vaccination proposal from TDH

You answer is exactly what I was looking for. If you are right about why the TVMA decided to issue the position it idid, then now I better understand why they did it.

<< it is likely that switching to this program will give the public 2 possible false impressions. . .
1. That we are of the opinion that rabies is on the wane in Texas, and 2. that we believe that all vaccines have a high probability of inducing disease and death. >>

I might be an idealist, but I don't like the idea of basing my medical decisions on how the misconceptions of others might be affected. I'd prefer to do what I think is medically appropriate for my patients and their owners, and not be prevented by law from doing so. I'd rather rely on frank communication between me an my client, to clear up any misconceptions that they may have.

<< The Texas Dept. of Health has recently asked TVMA to participate in a joint effort to get out the pet owning population to vaccinate their pets to guard against rabies, and from there to follow their doctors advice on how to follow up with future vaccines. This is where your data is correct and should influence active intelligent Veterinarians to synthesize your data so thoughtfully collected and apply it to their demographic and topographic locale. >>>

Currently, the law prevents me from doing this.

<< TVMA's position looks at what is likely to be the outcome of taking the scientific stance vs. the big picture of falsely imprinting in the less responsible pet owner that its okay to not vaccinate since the state is backing off of its recommendation at this time. >>>

Ok. . . . now I'm REALLY going to step on some toes. . . Perhaps the real mistake was in recommending annual vaccination with a triennial vaccine in the first place. Other states that did not fall into this trap do not find themselves in this public perception predicament. Had we never required overvaccination, we wouldn't be faced with the problem of how to explain vaccinating more appropriately. And had we been giving proper and legal informed consent as we should have been all along, and as MD's have been doing for many decades, our clients would already be properly informed regarding the possible adverse reactions to vaccines. Perpetuating these errors while we try to spin public opinion may not be the right thing to do.

<< TVMA's position is not to be based on the science, that is a different issue that we hoped will be addressed once the owner is responsible enough to do the right thing and get into the Vets office. >>>

Hmmmmm. . . . . So according to Doug, the TVMA is asking me to refrain from doing what is clearly medically appropriate for my patients, until such time as some undetermined number of Texas Pet owners are transformed from "uninformed" to "responsible. " Which of the two events below do you think will happen sooner?

1. Uninformed/irresponsible pet owners will become informed/responsible en bloc.
2. Pigs will fly.

Lighten up. . . That was a joke. . .

<< It is a concern that in the face of increasing reports of both Domestic and Sylvatic rabies currently in the state, that while the once yearly vaccine may produce the 0. 8 in 10, 000 cases of adverse reactions that the journal articles pointed out, it is a small price to pay for the prevention of one child getting rabies because of the wrong impression being given by TVMA if it were to support the three year adjustment. Remembering what that old footage in vet school of the child with rabies was going thru, it is my personal opinion as a parent that its worth the risk of causing the 1 in 12, 000 problems. >>>

I'm not sure that the trade-off you envision is truly a reality. And I'm not sure it's justification for basing medical policy on something other than what is clearly medically indicated. It is, however, a powerful "emotional" and "anecdotal" argument (couldn't resist using those words).

<< And now TVMA asks for your support in a united front for allowing us to shape the big picture for rabies prevention from a statewide perspective, not a test tube one. >>>

I support the TVMA financially at present, and have been an active committee member in the past. But I just can't support a law that requires me to increase risk of disease in my patients, with what I believe to be NO increase in protection of the pet nor of the people the pet interacts with. I'll do it of course, because it's the law, but I won't like it.

<< You are right Wendy, we are likely to cause some reactions, but this is a choice not based solely on facts and data, but also based on the human equation. >>>

I think we would do better to stick to the facts and data. Trying to predict human nature is a little more difficult, and I'm not sure how likely it is that we will be successful at doing so. In my opinion, the public has already gotten wind that we as veterinarians are continuing to vaccinate more often than is medically indicated. Recent news TV pieces, magazine and news articles clearly show this. If we continue to vaccinate more often than is indicated by the facts and data, we very well could be accused of using the "public health" argument as a thinly veiled attempt to protect out own financial interests. Don't get me wrong, I AM NOT accusing the TVMA of continuing to endorse annual rabies vaccines for financial reasons. But the well educated pet owning public might see it that way. And which group is likely to be more politically vocal--the well educated pet owning public, or the unconcerned pet owner?

<< We hope that you will bear with us while we attempt to educate the public and get them current >>>

I will continue to deal with this issue as honestly as I can. Each time I vaccinate a pet yearly with a triennial vaccine, I will continue to make every effort before I vaccinate to look the owner in the eye and tell them that there is no medical reason to vaccinate their pet, but that I am required by law to do so. And then I will proceed to tell them that there is a very small chance of adverse reaction, including death, just as when they give informed consent for vaccination of their own children or other family members, or give informed consent for their own vaccine(s).

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Msg # 7531

Subject: RE: [TexasVets] TVMA position statement on rabies vaccination proposal from TDH

<< Rabies serovars endemic to Texas are very unlikely to be transmitted to people from pets who might be infected, even if they are not vaccinated at all >>>

I based this statement on the information from Dr. Carter's post, which I quote below:

"I've discovered that rabies is fairly species specific as far as maintaining in nature & passing thru species. For example, bat rabies is highly virulent to almost any mammal bitten by a bat. However, that mammal isn't likely to pass it on or maintain it in its own species. . . My point is that humans or other species are unlikely to get rabies from a dog or cat that got rabies from a bat, skunk, or fox. We certainly aren't likely to get rabies from livestock that are positive. I don't know if there are any proven cases where a dog or cat infected another animal or a human with rabies of another strain. It is certainly possible in theory if that animal has virus in its saliva. Where we humans are likely to get rabies is from a bat, skunk, fox, coyote, raccoon, etc. with its own adapted strain. AND, we are likely to get it from a dog with Mexican dog/coyote strain rabies which is a dog strain adapted to coyotes. Dogs & coyotes pass this back & forth among themselves & infect anything else they bite. That is why the South Texas scenario was so inherently dangerous. Fortunately, either through the air drop oral vaccination program or possibly through a natural cycle, that situation has waned. . . . This leads me the issue of vaccination frequency & why Texas is not different from other places. The likelihood of a pet passing rabies on to a human is pretty miniscule in the absence of dog strain rabies in a dog. The issue of vaccination is herd immunity to prevent an outbreak that might be adapted to a domestic species (realistically this is probably only dog/coyote strain in dogs). We need to adequately vaccinate a large percentage of the susceptible population. This is particularly a problem in South Texas that gets worse as you go south. That is why the last outbreak almost got away from the authorities. "

I honestly don't know if there has ever been a documented case of transmission of rabies by an animals who was infected by a serovar belonging to another species. I looked for some time for more information on this issue, but just couldn't find anything. Maybe people from TDH could help with this question.

For what it's worth, here is an anecdote:

Charlie Hall at TAMU was bitten by a kitten in Snook, confirmed to be rabid on examination of its brain tissue. He never took PEP, because the test results were available more than 72 hours after he was bitten, or perhaps for other reasons that you would have to ask him about. He indeed did develop shooting pains in his trigeminal nerve for a little while, but did not develop rabies.

<< So why vaccinate at all ...>>>

To protect pets from a deadly disease, and to afford some small amount of protection to their owners. I AM NOT arguing against the importance of rabies vaccination--I think it is exceedingly important. I am simply arguing against overvaccination.

<< why give PEP to people exposed to rabid animals/pets..>>>

I'm not sure that routine vaccination can be compared to PEP. They are two different animals. If PEP is being considered, then the risk is exponentially higher.

Rabid wildlife is a completely different case than rabid pets. Rabid wildlife IS very likely to transmit a rabies serovar for which it is a reservoir to any warm blooded animal, including pets and people, so rabies PEP is especially crucial for these cases.

PEP is given to people who have been exposed to rabid pets for reasons determined by TDH. Since I am not a human MD, I really am not well versed with the risk-benefit assessment here--you'd have to take this question up with TDH. I am not sure if initial tests elucidate the serovar. If canine serovar can not be ruled out in a dog brain positive for rabies prior to the 72 hour window within which PEP must be started, I would think it would be prudent to go ahead with PEP.

<< why send heads to Austin for testing? >>>

I think we all realize the importance of sending heads of wildlife with neurologic disease or who have had contact with people or pets to Austin, because of the high risk of transmission of rabies to pets and people. And I think we are justified in sending the heads of unvaccinated dogs and cats with neurologic disease or exposure to wildlife to Austin. There is a small risk of this pet passing rabies to a person, but still a risk that I think outweighs by far the risk of letting human rabies go untreated, especially considering the high efficacy of human PEP. Human PEP hardly ever fails. Those people who die of rabies are usually those who do not receive PEP prior to development of neurologic signs.

However, I think it is absolutely ridiculous to kill an asymptomatic dog or cat and send it's head to Austin, simply because it has bitten a person, if it has no known exposure to rabies, and has been vaccinated for rabies with a triennial vaccine within the past three years. If the pet has been exposed to wildlife that is confirmed to be rabid, then I think we have a tough decision to make, even if the pet has been vaccinated according to the label. Though they are rare, vaccine failures do happen.

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Msg # 7535

Subject: RE: [TexasVets] TVMA position statement on rabies vaccination proposal

from TDH I've discovered that rabies is fairly species specific as far as maintaining in nature & passing thru species. For example, bat rabies is highly virulent to almost any mammal bitten by a bat. However, that mammal isn't likely to pass it on or maintain it in its own species. . .

I will be changing my rabies recommendations as soon as the state changes its recommendations, but no one I have ever known has had any desire to test the lack of transmission of a rabid animals' bite.

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Msg # 7536

Subject: Re: antivaccine advocates/lawyers/animalrights/economics

Very interesting news release Karen. This guy was able to get a feature article into the Wall Street Journal. For those of you who don't see the wave coming, you better look real hard. You need to ask yourself if you REALLY believe annual vaccines are needed or if you are doing it for liability concerns and financial concerns. The liability issue is likely to soon shift to those who give vaccines annually rather than less frequently.

It doesn't look good for the profession dedicated to animal advocacy to be painted into the image of needlessly vaccinating pets for personal gain. If we allow this guy and his kind to take control of this issue, we may find that their are other things on his agenda that affect us, like animal rights and "value beyond mere property" for their "animal guardians".

This may mean more for us as a profession, but it will certainly mean more for our insurance carriers! Companion-Animal Advocate Launches Crusade Against Over-Vaccination DENVER, Aug. 6 /PRNewswire/ -- James D. Schwartz, a recognized reformer of the financial planning industry, now is launching a crusade to change the vaccination practices of veterinarians -- and once again is receiving national attention. Schwartz's beloved standard poodle Moolah developed autoimmune disease and died after receiving an annual rabies shot.

"What happened to Moolah need not -- should not -- happen to another dog, " says Schwartz. "Unfortunately, it has happened to thousands of dogs and cats knowingly, willingly, systemically at the hands of economically motivated `professionals. '" Schwartz says, "In my opinion, some vets ignore research about vaccine risks for financial reasons. " The former Financial Planner of the Year has researched veterinarian-practice economics, performed financial analyses, and believes many veterinary practices would not be very profitable without the income generated through annual rabies shots and related office visits.

"Evidence is building that annual vaccination of dogs and cats -- performed for diseases such as rabies, distemper and parvovirus -- may not be necessary and could even be harmful, " states a Wall Street Journal article, published July 31, 2002. "Vaccines licensed by the U. S. Department of Agriculture are tested to ensure they protect pets against disease, usually for one year. But the tests don't detect long-term side effects, or measure the duration of a vaccine's effectiveness. "

Schwartz is calling upon veterinarians to change their vaccination practices and to provide pet guardians with the opportunity for "informed consent" by briefing guardians about the possible dangers and questionable benefits of annual vaccination shots. "Vaccine manufacturers' labels warn veterinarians that these medications should only be administered to healthy animals, " says Schwartz, a warning that is often ignored. The now-retired financial planner, who resides near Denver, CO, has established the Next To Kin Foundation to promote education and research into issues such as over-vaccination and the legal standing of -- what he prefers to call -- "companion animals. "

On the Next To Kin website (www. next2kin. org), visitors can consider Schwartz's financial analysis; see the official position of the American Veterinary Medical Association on vaccination; find questions to ask their own vet about his or her vaccination practices; and ponder Next To Kin's contention that companion animals have value "beyond mere property" that should be recognized under law. For further information, contact Next To Kin: 303-850-9166, e-mail: [email protected], or write: Next To Kin Foundation, 8547 East Arapahoe Rd. J197, Greenwood Village, Colorado 80112-1430.

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Msg # 7536

Subject: Re: antivaccine advocates/lawyers/animalrights/economics

Very interesting news release Kn. This guy was able to get a feature article into the Wall Street Journal. For those of you who don't see the wave coming, you better look real hard.

You need to ask yourself if you REALLY believe annual vaccines are needed or if you are doing it for liability concerns and financial concerns. The liability issue is likely to soon shift to those who give vaccines annually rather than less frequently. It doesn't look good for the profession dedicated to animal advocacy to be painted into the image of needlessly vaccinating pets for personal gain.

If we allow this guy and his kind to take control of this issue, we may find that their are other things on his agenda that affect us, like animal rights and "value beyond mere property" for their "animal guardians". This may mean more for us as a profession, but it will certainly mean more for our insurance carriers!

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Message 7538 of 7782 Previous Next [ Up Thread ] Message Index

Msg # 7538

Subject: Re:Re: antivaccine advocates/lawyers/animalrights

Isn't sad that the media will go to great lengths to find and sensationalize the rare, unusual, extremely low incidence, tragic( use what ever adjective you like ) situation like this.

I'd like to suggest the media interview the millions of pet owners who have older healthy pets that have never had distemper, parvo, hepatitis, panleuk or feline leukemia because they have been protected by vaccination. We may debate and discuss vaccination intervals till the cows come home but I would certainly hope that we could all unite behind the position that vaccinations save lives. When I went into practice 20 years ago, deaths from distemper were a common event. Not so now.

None would disagree that countless more lives are saved by vaccinations than are lost to a vaccination reactions. We need to take the media to task every time they sensationalize this issue with statements like "vaccinations kill or, is your vet killing your pet". I would suspect that in the long run this type of media coverage will result in a decrease in vaccination related problems but unfortunately it will be more than offset by an increase in deaths cause by these preventable infectious diseases.

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Msg # 7541

Subject: re: vaccines

<< WB and B, stick to your guns. Your arguments are persuasive and appreciated and not falling on deaf ears. Earlier this year, I modified my vaccination protocol for all the core vaccines because of them>>>

I want to just say 'thanks' also to Wendy for all the information, and to everyone for the thoughtful discussions. This is obviously a very heated issue, and I have been just reading and learning throughout it, but not 'participating' in the discussions about vaccines.

But, I have recently returned to day practice from the ER world, and I can't tell you how glad I am to have been reading all these posts. This is a wonderful format for all of us to learn from, even if we don't all agree! It's definitely influencing my discussions with clients about vaccine recommendations (and I've only been back in day practice two days! ) Thanks everyone.

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Msg # 7545

Subject: Vaccination topic: Let's be ready for the w-c-s!

NEWS FLASH - Reuters; 2006. Vets Take Heat for Disease Outbreaks Another outbreak of both the deadly canine distemper virus in the DFW area, and of the equally lethal parvovirus in the Austin area has killed thousands of dogs in the last few weeks. Less dangerous, but more widespread and perhaps expensive is an epidemic of viral infections in household cats in the Houston area in the last month.

The TDH is also investigating yet another insurgence of the rabies virus in livestock, pets, and wild animals in West Texas and may soon reinstate the bait-dropping program. Animal owners and activists are blaming Texas veterinarians for the resurgent of these formerly well-controlled diseases. "Them darn vit'naries told us we didn't need to give em' the shots anymore, and we trusted them", said bereaved pet owner Al Wayswhinin.

"We used to do it reg'lar an it worked fine, but they said 'No More' - and now they are all dying. ", he continueed. Veterinary officials commented lamely, "The information we had at the time suggested that the vaccines were causing more harm than good so we backed off. We have to put partial blame on the public for misinterpreting our intent to decrease the frequency of vaccination, NOT to stop entirely. " they continued, perhaps unnoticed. As if to dig the hole deeper, the official rambled on,

"We were seeing a rare vaccine reaction and even 1: 20000 fatalities, and the few who complained about this urged us to reduce vaccination frequency, so it seems like we can't win! " Owners of animals afflicted by the recent spate of illnesses may contact the state board to file substandard care charges against their errant veterinarians and also Mrs. Sue Yoo, attny at law, to join the pending class-action lawsuit.

Article lifted from the Austin Statesman, dated Aug. 6th, 2006. Is the above fictitious article what may be in store for us? If so I hope we will be ready!

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Msg # 7548

Subject: Re: Vaccination topic: Let's be ready for the w-c-s!

Addendum to Disease Outbreak Article 2006

Lawyers accuse vets of deliberately reducing vaccine frequency for financial gain. Vets report surging income from increased treatment of potentially lethal diseases previously well controlled. . . . . . . . ; -)

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Msg # 7549

Subject: Re: [TexasVets] Re: antivaccine advocates/lawyers/animalrights

They quit vaccinating for small pox. . . . . . . could be a problem? !

They said Leptospirosis was a non-issue a few years back. . . could be a problem? !

As many coaches have said over and over "the best offense is a good defense! "

From the standpoint of a vet who sees lots of exotics - they don't need vaccinations so they never see the vet. until it's too late. . . . . . . I await the first epidemic of 'La Rabia. ' in Texas as the laws are loosened!

On another note. . . anyone read their Fort Dodge update on Proheart? Any thoughts on giving or not giving with vaccinations? I have been shying away from offering this product to older dogs that possibly could die of something else within the next 6-12 months, because if they do - it had to be the shots fault! One older Golden died of a brain tumor the owner is convinced it was the shot.

. Another did that lethargy after the first and dead after the second (from another vet). injections. Otherwise, the public loves it and it gets them coming back to the clinic . . . . something has to bring them back, if they change the vaccination rules. . . . an annual exam only will bring in those loyal owners - the rest will need something concrete to come in and get!

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Msg # 7552

Subject: I see Cows ! ! ! Lets move on . . .

We may debate and discuss vaccination intervals till the cows come home I see cows. . . . . Lets move on. . . and agree to disagree. Wendy, I am sorry the TVMA is a less than popular choice than you would like. We will continue to kill dogs and save children. . . . . .

Just an anecdote. . . . Everyone is right here. . . everyone is wrong. . . . . . No good answers. Lets go back to having productive discussions, with an endpoint. I do resent the notion that everyone with a differing opinion is practicing medicine based on misconceptions.

You might consider the possibility that this is a tough choice for us, and all of the rhetoric and facts in the world wont change positions . But I can guarantee you this, in my area of the state, if you tell people to vaccinate less, even though I will be the first to agree that triennial should be enough, we will see an increase in human rabies cases.

Its simply the way it is in South Texas\ . Respectfully

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Msg # 7608

Subject: Vaccine, again!

Sorry to beat a dead horse, but I still am struggling with how to handle vaccines in the future. I am sure that somewhere in my subconscious I am worried about how it will affect my bottom line, but to tell you the truth, I still have not decided how I will vaccinate my own pets (2 dogs, 1 cat). I am also someone who will not push something on my clients if I can't justify it for my own animals. Here is a hypothetical situation: You personally own a dog that you vaccinated as a puppy at 4 months, repeated at 16 months and 28 months.

It is now 2 years since he has received his last rabies vaccine. You hear a rukus in the yard, go out and there is a raccoon attacking your dog which you dispatch, send the head in and it is positive for rabies. Are you going to boost the rabies that day for your dog? I would bet that 98-100% of us would. Now, how does that relate to my clients' animals. I would estimate that well over 50 % of my dog and cat patients (including all of my pets) reside for the most part outside. We are also in an area that consistenly has cases of rabies in bats, skunks, coons, foxes and all of these animals can be found in town most nights.

It is reasonable to assume that some my patients are being bit by a rabid animal each year. If I can not honestly say that I would trust the vaccines in my scenerio above, with the dog that plays with my 10 year old daughter, without giving a booster "just in case", then how can I tell my clients with certainty to not worry about their children even though their animal gets bit by a rabid animal and no one knows about the bite (assuming I switch to a 3 year vaccination schedule).

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Msg # 7554

Subject: Re: [TexasVets] no subject-Proving an allegation

I wonder what mechanism they went about utilizing to definitively rule in Vaccine autoimmnue disease. . . . . . . . . rather than autoimmune disease in general. <<<<

Doug and all,

I don't believe, in the atmosphere that exists today, any of these charges must be proven; they are stated, and anyone can do this. Then, the burden is on anyone who vaccinates, or whatever, to prove the allegation isn't so. . . . . . . . . . . . and, it can never be actually verified or disproven.

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Msg # 7609

Subject: Re: [TexasVets] Vaccine, again!

I probably can't tell you anything that will change your gut reaction. I can tell you that I could not find a single case of an animal in the United States developing rabies in the scenario you presented. There are a few cases in animals that had only received one vaccine. That is why the label says to booster at one year of age.

I looked both at cases submitted to the CDC and at the records for Iowa for the past 10 years and NO reports exist of animals developing rabies that had received the rabies vaccine and been boostered a year later and then according to label directions. With all of the rabies exposures in areas with higher levels of rabies than we have, that suggests to me that your dog would be protected without the booster.

New England has a higher incidence of the disease in wildlife, a lower frequency of vaccinations for domestic animals, and no signs that their vaccination frequencies are increasing the incidence in their domestic animals. ======================================================

Msg # 7611

Subject: Re: [TexasVets] Vaccine, again!

Very good info. However, you did not answer the question. Would you revaccinate your own pet in that situation? It is easy to quote statistics on a population and the data you quoted is compelling if true, but are you sure in one individual animal (yours in this case) that you would risk it?

What about the statement from the vet in south Texas of a dog that had 3 rabies vaccines at a "rabies clinic" and died from rabies? Granted, I suppose it is possible that the client was lying about the vaccines.

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Msg # 7614

Subject: Re: [TexasVets] Vaccine, again! Very good info. However, you did not answer the question. Would you revaccinate your own pet in that situation? David, I probably would boost my pet in that situation, even though it is probably not needed.

I would be willing to risk the possible negative effects of the vaccine just in case it were needed. Another approach to the whole vaccine issue might be to do as I saw on VIN today. In this locale, Pennsylvania I think, there are door to door visits by animal control officers with a $200 fine for dogs and cats that are not current on rabies vaccinations.

A realistic expectation of significant financial coast might do more than anything else to reduce our pool of unvaccinated pets. But I am not too sure I want the government that involved. : ))

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Msg # 7617

Subject: RE: [TexasVets] Vaccine, again!

I think you are confusing pre-exposure prophylaxis with post-exposure prophylaxis. They are two different animals. << Here is a hypothetical situation: You personally own a dog that you vaccinated as a puppy at 4 months, repeated at 16 months and 28 months.

However, whether the dog has been vaccinated two weeks ago, last month, last year, or three years ago, a booster is in order if euthanasia (which is the first recommendation) is not an option. When an animal or person has definitely been exposed, then the risk of disease becomes

MUCH greater than the risk of vaccination, so a booster is always indicated, followed by strict isolation, or whatever other PEP is recommended by the state health department. When making decisions about pre-exposure prophylaxis, the risk of disease is MUCH smaller, and perhaps less than the risk of vaccination when you look at the numbers in Texas.

So while erring on the side of caution when there has definitely been an exposure is without question to give a booster, erring on the side of caution in pre-exposure prophylaxis in my opinion is to not re-vaccinate animals who are extremely likely already immune.

Most of the rest of the world, more than 40 other states, all of the professional organizations who have taken a position, and all but one vet school would trust a three year vaccination protocol--many states have for decades. I'm not sure why vets feel so differently in Texas.

Believe it or not, Texas is NOT one of the states with the highest rate of rabies per square mile. But it might be the state with the most vets per square mile who think that annual vaccination with a triennial vaccine is appropriate.

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Msg # 7618

Subject: Re: [TexasVets] another vaccine question What is wrong with this logic? We as vets who own a dog should vaccinate our personal dog for his full series as a puppy and never again. From the data people have presented, he shouldn't ever need one again. After all, if we have him fully immunized as a puppy I would think it would be a pretty safe bet to say that he will be exposed several times a year by us bringing parvo home from the office.

Ok, you are better at isolation technique than me, so "I" will be bringing it home several times a year. This should be sufficient to keep his immune system fully operational for parvo for the rest of his life! Maybe I am not a great immunologist and there is a flaw in my logic, but if not is anyone out there ready to do that? I'm not. According to Dr Ron Schultz a dog or cats immune system does not mature until they are 6 months old. One more vaccintion after 6 months for Rabies DHPP is recommended.

We dont usually see them back until 1 yr 4 mo. It is my suggestion, and I understand common practice in Alaska to give two rabies vaccinations initially at 4 & 5 months. Why wait one year for the amnestic response? espsecially in an epidiemic area? All those vaccinations you have been giving at 2yrs, 3 yrs etc have had no effect. We just thought we were boosting our patients. I have been telling my clients that the DHPP at 1 yr 4 months is good for life for 4 1/2 years. I have not seen one break.

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Msg # 7619

Subject: Rabies Vaccination Failures

From Clark, Javma June 1 96, and Javma Feb 15 2001From 1979-87 440 unvaccinated dogs and 57 unvaccinated cats received PEP after known rabies exposures. Only 2 dogs developed rabies, one 3 mo old and 1 yr. old. From 91-94 632 unvaccinated know exposures received PEPs with 6 failures.

From 95-99 3 dogs developed rabies after only one vaccination at 3 months of age and 1 dog developed rabies after 2 rabies vaccinations. I have been told repeatedly to give the first rabies vac as close to 4 months as possible because a few dogs will still have maternal antibodies out to 14 weeks. If a bite victim gets the rabies virus exposure into the CNS, ie a deep bite on a facial nerve, all the vaccinations in the world will not prevent rabies.

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Msg # 7620

Subject: post exposure

Wendy, I think you seem to have missed the point I am trying to make. I understand you position on post exposure. My point is I AM talking about probable post exposure vaccines in some of my patients (and I don't know the ones who need it). Should we make a blanket statement to all our clients that every 3 years is the way to go, or should we present both sides of the issue and let them make the decision?

If their son or daughter plays daily with their outside dog and they are presented with the facts that there is a 99. 9% chance their animal is protected even if it has been 3 years and there is a 1 in 10, 000 chance there dog may die from annual vaccinations, a fair amount may opt to continue the annual vaccinations. I may still opt for the chance of vaccine reactions on my personal animals where my children are concerned. For my clients to whom their dog IS their child, obviously, they would choose the 3 year protocol.

Also, where do you get your data that Texas is not at the top in rabid animals per square mile? Remember, statistics can lie! There are a lot of areas in Texas with low incidence of rabies and because Texas is a BIG state, that artificially lowers the case/sq mile. If you can show me that just the counties around the Houston area (which I seem to remember is very high in reported cases) has a lower case/square mile than the other areas you cite, then the data is significant. Also, do these other states have the diversity of different strains of rabies we seem to have: skunk, fox, coyote, and bat.

Don't know if that would be significant or not, but it seems that when you have so many different animal strains, that may be significant when compared to states that say primarily just have raccoon rabies as far as potential exposure. It is Friday night, I am not on call, and I am ready to think of other things, have a good weekend!

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Msg # 7621

Subject: Rabies Vaccination

List, Dr. B brings up the point that seems logical to me. Although I have enjoyed the argument over annual use of triennial vaccines and have learned from the various debaters, it seems that the true problem has been minimally addressed. If I am heading to farm calls at 85 mph and every 5 miles is a posted speed limit sign, it won't slow me down.

If there is a sign stating violators will receive a $1000. 00 fine or 6 months in jail, I will probably slow down. If our problems are that we are over vaccinating a portion of pets and under vaccinating a larger portion of pets, why wouldn't it make since to follow the scientific evidence and place the onus of responsible pet ownership on the pet owning public?

Since there is a public health issue why not create a state-wide enforced requirement for a three year rabies vaccination for small animals. Obviously this isn't going to happen because it seems over-reactive to our current situation and we are fearful of more "government" involvement, but isn't it closer to a solution than what has been discussed so far?

I know that there are certain clients that I would love to scream "citizens arrest" at (just like Gomer Pyle) and have them hauled off to the pokey for irresponsible pet ownership. As an aside what would we do with all the wolf hybrids since there is no labeled vaccine? What's that? I hear my technicians screaming "citizen's arrest"!

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Msg # 7639

Subject: RE: [TexasVets] post exposure

<< Should we make a blanket statement to all our clients that every 3 years is the way to go, or should we present both sides of the issue and let them make the decision? If their son or daughter plays daily with their outside dog and they are presented with the facts that there is a 99. 9% chance their animal is protected even if it has been 3 years and there is a 1 in 10, 000 chance there dog may die from annual vaccinations, a fair amount may opt to continue the annual vaccinations.

I may still opt for the chance of vaccine reactions on my personal animals where my children are concerned. For my clients to whom their dog IS their child, obviously, they would choose the 3 year protocol. I don't think that question can be answered by me. I believe that dogs and cats are very well protected by vaccinating with a triennial vaccine every three years. So that's what I'll recommend if I am ever allowed to do so.

If you think that there are good reasons to continue vaccinating every year, of course you should continue to offer it to your clients. If the new TDH recommendations are passed we can both do what we think best for our clients. What's so bad about that? << Also, where do you get your data that Texas is not at the top in rabid animals per square mile? CDC--a pretty reliable source of data on rabies: http://www.cdc.gov/ncidod/dvrd/rabies/Epidemiology/Epidemiology.htm#United%2 0States%20Rabies%20Surveillance%20Data, %201996.

There are indeed data that support the idea that humans in Texas are at higher risk for death due to rabies than in other states, regardless of the number of cases of confirmed rabies per square mile. I don't know if this because Texans are more likely to be exposed to rabies, less likely to report exposure and get PEP, or both. There have been 31 cases of rabies in humans reported in the past decade throughout the United States. Six of those cases were infected in another country, but diagnosed in the US.

Twenty were exposed in other states. Interestingly enough, 5 cases were in Texas. That's 16% of the human cases in the US, and 20% of those thought to be infected in the US--quite a few. Texas owns only 7-8% of the US population. Of the five deaths in Texas, three were the bat serovar, and two canine serovar. Rabies PEP is highly effective and hardly ever fails. Those who die of rabies are usually those who either did not know they were exposed, or did not report the exposure so that it could be treated. 24 of 31 of the people who died of rabies in the US during the past decade had unknown exposure (24 of the 25 people thought to be infected in the US).

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Msg # 7641

Subject: RE: [TexasVets] Rabies Vaccination Failures

Here is the actual abstract that Dr. B quoted: Postexposure Rabies Prophylaxis Protocol for Domestic Animals and Epidemiologic Characteristics of Rabies Vaccination Failures in Texas: 1995-1999 J Am Vet Med Assoc 218[4]: 522-525 Feb 15'01 Public Vet Med 12 Refs Pamela J. Wilson, MEd & Keith A. Clark, DVM, PhD Texas Department of Health, Zoonosis Control Division, 1100 West 49th Street, Austin, TX 78756

OBJECTIVE: To determine whether postexposure rabies prophylaxis (PEP) in domestic animals, as mandated by the state of Texas, has continued to be effective and to evaluate PEP and preexposure rabies vaccination failures from 1995 through 1999. DESIGN: Retrospective study.

ANIMALS: 830 unvaccinated domestic animals (621 dogs, 78 horses, 71 cats, and 60 cattle) that received PEP and 4 animals (3 dogs and 1 horse) that had preexposure rabies vaccination failure.

PROCEDURE: Zoonotic incident case reports from 1995 through 1999 were reviewed for information regarding unvaccinated domestic animals that received PEP according to state protocol after exposure to a rabid animal; reports were also reviewed for information regarding preexposure rabies vaccination failures. The PEP recommendations were to immediately vaccinate the animal against rabies, isolate the animal for 90 days, and administer booster vaccinations during the third and eighth weeks of the isolation period. Rabies vaccines used in the PEP protocol were administered via the route prescribed by the USDA.

RESULTS: From 1995 through 1999, 830 animals received PEP; 4 failures were recorded. Additionally, 4 preexposure rabies vaccination failures were recorded.

CONCLUSIONS & CLINICAL RELEVANCE: Results of this study indicate that an effective PEP protocol for unvaccinated domestic animals exposed to rabies includes immediate vaccination against rabies, a strict isolation period of 90 days, and administration of booster vaccinations during the third and eighth weeks of the isolation period. This PEP schedule has proven to be effective for control of rabies in domestic animals. Here is another AJVR abstract hot off the press (August 2002). Postexposure prophylaxis for prevention of rabies in dogs. Hanlon CA, Niezgoda M, Rupprecht CE. AJVR 63: 8, August 2002 1096-1100. Objective: To evaluate postexposure prophylaxis (PEP) in dogs experimentally infected with rabies. Animals: 29 beagles.

Procedure: Dogs were sedated and inoculated in the right masseter muscle with a salivary gland homogenate from a naturally infected rabid dog (day 0). Six hours later, 5 dogs were treated by administration of 2 murine anti-rabies glycoprotein monoclonal antibodies (mAb) and commercial vaccine; 5 received mAb alone; 5 received purified, heat treated equine rabies immune globulin (PHT-ERIG) and vaccine; 5 received PHT-ERIG alone; 4 received vaccine alone; and 5 control dogs were not treated. The mAb or PHT-ERIG was administered at the site of rabies virus inoculation. Additional vaccine doses for groups mAb plus vaccine, PHT-ERIG plus vaccine, and vaccine alone were administered IM in the right hind limb on days 3, 7, 14 and 35.

Results: All control dogs and dogs that received only vaccine developed rabies. In the PHT-ERIG and vaccine group, 2 of 5 dogs were protected, whereas none were protected with PHT-ERIG alone. Use of mAb alone resulted in protection of 4 of 5 dogs. Administration of mAb in combination with vaccine provided protection in all 5 dogs.

Conclusions and Clinical Relevance: Current national guidelines recommend euthanasia of a 6-month quarantine for unvaccinated animals exposed to rabies.

Findings from this study document that vaccine alone was unable to provide protection from rabies. However, vaccine combined with mAb resulted in protection in all treated dogs, revealing the potential use of mAb in PEP against rabies in naive dogs.

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Msg # 7719

Subject: Re: [TexasVets] Rabies Vaccination Failures

In a message dated 8/10/02 6: 29: 56 PM Central Daylight Time, WB writes: The mAb or PHT-ERIG was administered at the site of rabies virus inoculation

WB: Do you think this would work in the real world? Can we know where all the bites are in order to inject the antibodies there? Though the results (5 out of 5 protected) are impressive, I have doubts that this has merit in real world exposures to rabies, unless the antiserum is effective by parenteral administration.

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Msg # 7720

Subject: Re: [TexasVets] Vaccine, again!

So are you now purposing we should change the guidelines for boostering exposed animals, as well? ! The problem with scientific research is it is usually big on theory and lacking in true life experiences!

Experimentation is controlled by nature - Nature is unfortunately not controlled. I would rather err on the side of proven safety than on a chance laboratory theory.

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Msg # 7721

Subject: RE: [TexasVets] Rabies Vaccination Failures

<< WB: Do you think this would work in the real world? I have no idea. It seems to me that there are many practical limitations: 1. How expensive is the stuff, and how easy is it to get? 2. How many vets are willing to handle and expose their staff a pet who has definitely been bitten by a rabid animal?

This would mean that these people would also need to receive PEP. Treating the wounds directly would potentially directly expose the medical caretakers to the virus directly. Sounds pretty risky to me. Casual exposure to a pet who has been exposed to rabies is one thing. Digging around in their fresh bite wounds is another. 3.

I think that finding the bite wounds an infusing them would be less problematic--we are accustomed to finding, clipping and cleaning bite wounds--we would then have to add infusing them with anti-serum. You could do it under sedation if needed. It doesn't seem too likely to me that many practitioners in the real world will be embracing this PEP treatment method, but I thought I'd let everyone who doesn't read AJVR (not the most entertaining read) know that it has been done and it does appear to be effective.

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