The Practice Success Prescription: Team-Based Veterinary Healthcare Delivery by Drs. Leak. Morris Humphries
Thomas E. Catanzaro, DVM, MHA, FACHE, DACHE
Figure 12: Human-Animal Bond Programs for a Changing Environment
Click on the figure to see a larger view.
Since we have no readily available and reliable way to determine if each patient has developed an adequate immune response, we encourage the practice philosophy of vaccinating more patients while vaccinating each patient no more than needed. - AAHA Task Force Summary JAAHA, Mar/Apr 2003, Vol.39, pg 121
The new fact is that the AAHA task force has written abundant guidelines for vaccinating our canine patients (AAHA, 2006), and even shared the "estimated titers", reflecting the "estimated minimum duration of immunity (DOI)". The kicker is in the article's summary section, which included the above statement. There has not yet been anyone or any company to come forward and support the individual practitioner or practice when the case goes to court. You are on the limb all by yourself.
The AAHA Canine Vaccine Task Force had fourteen members, twelve of them diplomates, yet that will not help your case, when they read the summary statements. The complete AAHA Canine Vaccine Task Force report is available from www.aahanet.org. Let me summarize the "AAHA vaccine guidelines":
Table 7: AAHA Vaccine Guidelines
|
Vaccine |
Initial Puppy |
Initial Adult |
Re-vaccination |
|
K-9 Distemper
(CDV) (MLV) |
One dose at six to eight weeks, nine to eleven weeks, and twelve to fourteen weeks. |
One dose. |
After a booster at one year, once every three years. |
|
rK-9 Distemper
(rCDV) (recombin) |
One dose at six to eight weeks, nine to eleven weeks, and twelve to fourteen weeks. (A dose more than four weeks after the last dose in this series will significantly increase the likelihood of sterile immunity equals complete prevention of infection.) |
Two doses, two to four weeks apart. |
After a booster at one year, annual after that. (May take longer to protect Immunologically naive dogs. Therefore, not recommended where CDV is a serious threat for puppies. Minimum DOI for rCDV is one year. If l MLV-CDV is used for initial series, followed by rCDV, every three years would be reasonable.) |
|
Canine Parvovirus (CPV-2) (MLV) |
One dose at six to eight weeks, nine to eleven weeks, and twelve to fourteen weeks. |
Two doses, three to four weeks apart. |
After a booster at one year, revax every at three years after that. |
|
K-9 Parvovirus
(CDV) (killed) |
One dose at six to eight weeks, nine to eleven weeks, twelve to fourteen weeks, and fifteen to seventeen weeks of age. |
Two doses, two to four weeks apart. |
After a booster at one year, once annually until DOI studies show longer protection. (When puppy receives MLV and is revaccinated at one year with MLV, then product could be used as booster > three years.)
(Not recommended for animals at high risk, e.g. shelters, kennels, puppy/pet stores.) (Maternal antibodies can interfere as old as sixteen to eighteen weeks.) |
|
Canine Adenovirus (CAV-2) (MLV) (killed), or (MLV topical) |
One dose at six to eight weeks, nine to eleven weeks, and twelve to fourteen weeks. |
Killed -- two doses, three to four weeks apart. MLV -- one dose. |
After a booster at one year, revax every three years after that. |
|
K-9 Rabies -- one year (killed) |
One dose as early as three months. |
One dose. |
After a booster at one year, local laws apply, can be used as booster required by statute for travel requirements. |
|
K-9 Rabies -- three years (killed) |
One dose as early as three months. |
One dose. |
After a booster at one year, revax every three years provides protection. Laws apply. Can be used as booster required by statute for travel requirements. |
|
Distemper-Measle
(D-MV) (MLV)
(Give IM ONLY) |
One dose between four and twelve weeks only .Followed with one dose of MLV-CDV, or two doses of rCDV, after twelve weeks. |
Not for dogs over twelve weeks of age. |
No subsequent use. May cause adverse effect to puppy if given to breeding female. |
|
Parainfluenzavirus (CPIV) (MLV, or MLV topical) |
One dose at six to eight weeks, nine to twelve weeks, and twelve to fourteen weeks of age. |
One dose (common as intranasal with Bordetella b.). |
Parental and at one year; revax once every three years thereafter. |
|
Leptospira interrogans (killed
(W/canicola and icterohaemorrhagiae) |
One dose at twelve weeks, and second at fourteen-to sixteen weeks. |
Two doses, two to four weeks apart. |
Revax annually (booster at six months, when local incidence is high-risk). |
|
Bordetella bronchiseptica
(killed bacterin) |
One dose at six to eight weeks, and then at ten to twelve weeks of age. |
Two doses, two to four weeks apart. |
At one year. Revax more often, when in high-risk. (DOI is approx. nine to twelve months.) |
|
Bordetella bronchiseptica
(live avirulent
+ Parainfluenza Virus (MLV-topical -- intranasal) |
One dose as early as three weeks and again after six weeks of age. |
Single dose. |
At one year. Annually, and if more than six months, booster one week before known risk (show, kennel, boarding, etc.). |
|
Bordetella bronchiseptica
(live avirulent)
+ CPIV (MLV)
+ CAV-2 (MLV) -- topical (intranasal) |
One dose > eight weeks. Can be used at three to four weeks of age in high-risk areas. |
One dose. |
At one year. Same for intranasal CPIV. (DOI is approximately same as above.) |
|
Borrelia burgdorferi (Lyme) (killed whole bacterin) |
One dose at nine or twelve weeks, and second at two to four weeks later. |
Two doses, two to four weeks apart. |
Revax annually in high-risk areas (beginning of insect, tick, season). (DOI is approximately one year.) |
|
Borrelia burgdorferi (rLyme
(recombinant outer surface protein A - OspA) |
One dose at nine weeks, with second at two to four weeks later. Optimal age for initial dose is > three months, with second dose two to four weeks later. |
Two doses, two to four weeks apart. |
Revax annually in high-risk areas (beginning of insect, tick, season). (DOI is approximately one year.) |
|
K-9 Coronavirus
(CCV) (killed or MLV) |
One dose at two to four weeks, and then every two to four weeks until twelve weeks of age (killed). |
Two doses two to four weeks apart. (Not Needed in adult dogs.) |
Not recommended until product demonstrates a benefit. (Has not shown effect, even when combined with CPV-2.) |
|
Giardia lamblia
killed) |
One dose at eight weeks, and second two to four weeks later. |
Two doses, two to four weeks apart. |
Boosters not necessary in dogs > one year of age. (Vaccine may prevent oocyst shedding, but does not prevent infection. Subclinical cases often in puppies and kittens. Suspect USA human contamination from water, not zoonotic from pets.) |
|
Canine Adenovirus (CAV-1) (MLV, or killed) |
One dose at six to eight weeks, nine to eleven weeks, and twelve to fourteen weeks. |
Killed -- two doses, two to four weeks apart .MLV -- one dose. |
After a booster at one year, revax every at three yearrs after that. Not recommended, because of "hepatitis blue eye" reactions. CAV-2 will cross- protect against CAV-1 and is safer. Vaccines with CAV-1 not recommended. |
Rubber Meets the Road Time
The above table is provided to show the practice just what material is being made public, and it will be the proactive practice that minimizes the client response, those not coming in for annual vaccines. The AAHA task force also stated, "...informed consent...is an ethical and legal requirement of biological use....Vaccine decisions must be approached like any other medical decision."
We have seen a few alternatives already effectively working with skip-year vaccines:
Some practices refuse to deviate from the biological label until someone is willing to officially share the liability. Some vaccine manufacturers say they will support skip-year vaccines. As yet, nothing has been provided in writing.
Stagger the vaccines so only one vaccine is given at a time, and only one three-year vaccine is given a year.
Make the annual life cycle consultation a requirement for receiving vaccines (see Title 12, CFR). Determine eligibility for the companion animal to be shifted to a skip-year protocol.
A few practices have started to give vaccines away, to remove the cost of the vaccines from the client's excuse/claim process, and they have concurrently ensured the consultation fee is adequate to cover the vaccine cost.
We like our consulting partner clients to link the annual life cycle consultation to the preferred client program VCI® Signature Series Monograph Client Relations Zone Operations).
We actually prefer the healthcare delivery system where the annual life cycle consultation is not planned to be a visit when anything invasive is done.
We want the patient back at least four times a year. As one dog year equals seven human years, this equals the clients' once-per-two-years visit to their own doctors. Many of those visits are with the nursing staff, saving the client the doctor's consultation if the animal is healthy.
The client relations specialist always commends the client for being a "preferred client", when the client has been in within the past twelve months for a doctor's annual life cycle consultation. The client relations specialist offers the short and economical ten-minute, in-and-out, nursing appointment for wellness, fecals, blood draws, weigh-ins, etc., and always asks if the client has questions and would prefer to see a doctor.
About seventy-five percent of the clients chose the doctor option, when given, but we also get the twenty-five percent who are now accessing care at the "media advertised rates" of the community.
When a client requests to have all the needs done at the same time, we meet their need (check the [ ]).
A sample "Preferred Client Letter" is provided in Appendix T to give you a starting point in your adaptation of the new vaccine standards to your own practice philosophy.
The veterinary profession is changing, from extended DOI (skip-year) vaccines to chemical sterilization of dogs, to new digital imaging techniques. We are getting new in-house surveillance lab tests for ERD, cardiac enzymes, Giardia, etc., to facilitate threat screening and proactive treatment protocols before the onset of signs, which is difficult for some tertiary care specialists to understand, since they are into definitive diagnostics at their level of care.
The Juvenile Pubic Symphysiodesis (JPS) procedure at four months of age, to eliminate hip dysplasia onset in eight-five percent of the dogs prone to this debilitating genetic defect, is another form of proactive wellness care (go to www.vetsurgerycentral.com/jps.htm). Modern companion animal veterinary practices have a choice of fighting the trends and being left behind, or embracing the changes and modifying their healthcare delivery modality to team-based systems that embrace the cutting edge of technology, while maintaining the high-touch caring that client's desire. The choice is an individual practice decision.