73 replies to this topic

[Sue R]

So, AKDogDoc, do you recommend annual vaccinations or titering as the best alternative? I didn't titer this year but I didn't vaccinate for anything but rabies, after doing all the puppy shots and revaccinating at 1 1/2 and 2 1/2 years of age.

It sounds from your posts that titering may not be all it's cracked up to be. If so, would you go with annual revaccinations (and rabies at whatever is required by a person's state) or with titering, and then vaccinating if sufficient immunity levels are not indicated?

[AK dog doc]

Well, your choices are vaccinate yearly, titer or go with an educated guess (which is essentiually what AAHA guidelines are... they base this guess on some very good research, but IRL no one knows what the immune status of a given dog really is unless it's tested in THAT individual. The guidelines are what one would EXPECT the dog's immunity to be, based on the research evidence - but that evidence was taken from *other dogs*, not the one in front of you. Does that make sense? I don't feel like I'm explaining that very well). I'd prefer titering to guessing, TBH. I didn't mean to give the impression that titers are not a good idea or 'not all they're cracked up to be'. The point I was trying to make is that titers don't tell you EVERYTHING about the individual status of immunity - they certainly tell you SOMETHING about it, and something very important. It just isn't all there is to know, but there currently isn't any good way to GET everything there is to know, at least not in a practical clinical setting. You could do challenges, for instance, where the animal is deliberately exposed to the causative agent, and see if the animal resists it or not; that would be the definitive way to see if the animal is immune, but realistically, that's not going to happen - and it carries some significant risks as an approach, anyway.

Every animal is individual in its resitance to disease. The human example that a lot of people may be familiar with is plague. There is a gene which confers resitance to it. If you have one copy, you get sick, but recover. If you have two copies, you con't get sick. If you have no copies you get sick and die (unless modern medicine intervenes.) The individual's genetics determine how well they withstand the disease. The same is, in a general way, true for memory cells.... some animals will "remember" the pathogen longer and better than others. The same individual animal may remember parvo really well, but not be so good at remembering distemper, for instance. This is why titers are nice to have - it lets you know what THAT animal remembers. It doesn't maybe tell you EVERYTHING it remembers, but it tells you something. It's like if someone asks you, "Do you remember in 1992 we went to Lake Tahoe?" and you might go "Nope!" and your sister goes, "Yup!" Well, that's sort of the "titer" of memorability of the Tahoe trip. Your sister's titer says she remembers it and no further testing or prompting is required. Your titer says you DON'T remember it. Now, maybe you DO remember it, but just not based on the question asked. If they then say, "Do you remember learning to water ski?" then you might go, "Yeah, was THAT what you meant by the Tahoe trip? Of course I remember it, how could anyone forget a thing like that?" That would be sort of like your cellular memory of the trip (which, remember, we don't currently have a practical way of testing in-clinic). If you don't remember that, maybe it's time for someone to get out the video tape to remind you about it, or perhaps take you back to Tahoe to trigger your memory, which would be like the booster shot, or slap a pair of skis on your feet and throw you off the dock. That's sort of doing the challenge - exposing you to the situation and seeing if you really DO remember how to ski, or if you need to learn all over again. In rare cases, you've forgotten how to water ski altogether, and have to start again from scratch.

So, to recap, I'd prefer titers to guessing, and also (TBH) to doing annual vaccines willy-nilly for most of the viruses. As stated earlier, Bordatella probably needs annual boosting, and Leptospira may need more than a three-year as well. Probably in most dogs just going by the guidelines is going to be adequate, but you can't REALLY know unless you test.

I don't at all mind going over the virus-vs-bacteria thing, but it's a gorgeous day here (40 degrees and sunny, and I'm starting to see glimpses of mud through the inches of ice in my back yard! yay! Sheesh. That sounds pathetic, being so thrilled about mud, but there you are. Springtime in AK.) I want to go spend some time outside with el doggos, maybe try to rake some of the frozen poo out of the melting ice (man... you really gotta have spring fever bad if THAT sounds like fun.) Plus my eyes are going crossed and sting-y from staring at the screen too much. So with your indulgence, I'll do that later.

[airbear]

Originally posted by AK dog doc:
...Does that address the question(s) you had? If not I'll try to locate some links for you (but it was easier just to expound a little out of my own head for the basics, since I had that info "on hand" already!)

Absolutely, and thanks so much for taking the time to write all of that! I will have my mom (the chemist) have a look through so that she can explain it to me (the non-chemist).

Thanks again!

[lucieluv]

I'm sure no one wants to hear this, but I'm posting it anyway.

My lab Lucie, who is 7 years old, became extremely ill two years ago about two weeks after she had her yearly shots. When I realized something was wrong with Lucie, it was the weekend so I called the Emergency Clinic. I explained that she wasn't acting right and I wanted to bring her in. After a little arguing I brought her in and they did blood work and we were sent home. By the time we got home, the Clinic had called back and said I needed to bring Lucie back as soon as possible, she was extremely sick.

This is what I was told...the vaccines that she received did what they were supposed to do but they also began killing her red blood cells, which was making her sick.

I'll leave out everything that we have been through over the last two years, at this point I'm happy that she is still alive and a happy dog. She continues to take medication everyday and will for the rest of her life. The cost of her illness has been greater than $12,000. The company that produced the vaccine offered me $500 to help with her medical expences.

She was trained to be a therapy dog and I was in my last year of graduate school for social work. I had planned on she and I working together with children. She can't work anymore and she doesn't understand why. She still has the greatest personality and is one of the most lovable dogs, it breaks my heart that she isn't able to share that love with children.

Liz

[AK dog doc]

Okay, on the virus VS bacteria thing...

As a by-and-large thing, viruses stimulate a response by the specific arms of the immune system while bacteria tend to stimulate more of a reaction from the non-specific defenses. This is part of why you can have chronic bacterial infections that are difficult to clear, and also why you can have repeat infections from the exact same bacterial strains over and over again. Viruses, as a general rule, usually stimulate a longer-term resistance and one that is specific to *that virus*. When you get a cold every year, that's a NEW cold virus each time, because the virus has mutated or a new one has come along. You CAN also have chronic viral infections, but these are usually the kind of virus that splices itself into the host genome and remains hidden inside the cell most of the time (as in herpes), or else the kind which destoys the immune system that is intended to destroy IT, via invasion of the immune cells themselves (as in FeLV or HIV).

Liz, I'm sorry you had such a horrible and life-threatening event with your dog, and I'm very glad she's still with you. We do see vaccine reactions from time to time, though those are FAR more rare than the morbidity and mortality that we see from distemper, parvo, hepatitis, leptospira, etc, for which we vaccinate. It sounds as if Lucy had auto-immune or immune-mediated hemolytic anemia (AIHA or IMHA)? If so, I have to point out (in the interest of medical clarity) that this disease happens sometimes, whether or not the dog has been recently vaccinated. A vaccine MIGHT be a contributor to such an event (and it certainly might have been in Lucy's case, though I'd be curious to know how that was proven, or if it was more of a speculation); but it could also be coincedental. I've treated a number of these dogs (and owned one myself), and none of them had been recently vaccinated. Also, in the case of my own dog (and at least some of the others), she was vaccinated again later (repeatedly) and never had a repeat episode of IMHA, which means that vaccine can have had nothing to do with it. Unfortunately, IMHA carries about a 60% mortality rate; other immune-mediated diseases vary in terms of their morbidity and mortality. As a BTW, there IS a breed predisposition to immune system disorders (Cockers, Lhasas and Labs for IMHA, for instance), but any breed or mix can have them (mine was a schnauzer-poodle mix). The immune system, elegant and complex and beautifully intricate as it is, is not a perfect system. Errors do sometimes occur, and may be short-term or choronic. The immune system is MEANT to be lethal (besides patrolling against pathogenic invaders, it also patrols for malignant and other abnormal "self" cells and dsetroys them before they become a malignant growth). Mechanisms are in place that prevent it from going after normal "self" cells and molecules, but sometimes that goes a bit haywire. To me it's a miracle that that doesn't happen more often. In a sense we all live in in the middle of a munitions site. As long as everything goes as planned, everyone stays safe and invaders are repelled and tunrcoats are destroyed before they wipe out the home base. If something goes wrong - like for instance, ordinance blows up - it may damage important parts of the home base, or trigger a chain reaction that might destroy the whole thing unless it's somehow reined in. At any rate, I hope Lucy continues well in your excellent care.

So, if I haven't answered the questions about the immune system adequately (or if my explanations are muddy), let me know. Immuno was (if you can't tell) one of my very fave subjects in both undergrad and vet school, so I'm not TOO sad to "have" to discuss it.

[lucieluv]

Thank you for explaining Lucie's condition to everyone. I didn't want to even try!! All though I have a good understanding of it now, I don't feel that I could explain it to anyone else.

Lucie has the immune-mediated hemolytic anemia type, and it really was just speculation that the vaccine was the cause. However, she was health prior to the vaccine and now if she is given so much as a Heartworm pill she becomes ill. I'm always looking for new treatments for Lucie. The current treatment and usually the treatment of choice can be just as harmful.

But, due to all of this, my dogs get titers now, not yearly vaccines. (Except for what is required by law!!)

[nancy in AZ]

AK Doc, thank you so much for contributing your expertise to this forum. It's getting more difficult to separate rumor from truth, fact from fiction with the vast amount of info available on the internet.

In my case, my little ACD had a series of focal seizures last year (4 in 4 months). She was seen by a veterinary neurologist. After viewing the results of an MRI, the neurologist felt the seizures were likely the result of a vascular event in her brain. Going forward, she recommended that all future vaccines (except the required rabies) be avoided. My vet said he would follow this protocol, but he didn't really agree with it. She is 10 years old, and I figured she's probably had enough vaccinations that her immune system is protected. Even so, I've struggled with this issue,weighing the recommendation of the specialist against the opinion of my personal vet (who has *never* let me down). On a similar note, by brother developed a serious auto-immune system disease following vaccinations he received before going to south Asia. Were the vaccines responsible for triggering his disease or would it have surfaced anyway-who can say for sure?

[AK dog doc]

I was just re-reading this post to be sure there wan't anything I left out (yeah, like I could include everything there is to know about this.... what am I saying?!? )

I did forget to point out that the immune system gears up to respond to both novel and "known" invaders (things it remembers) if it is NORMAL - if the animal is immunosuppressed or has another immunodeficiency, this may not happen. Even a "small" immonodeficiency - such has having IgG subclasses 2 and 4 but not 1 and 3, for instance - can prove fatal.

I also wanted to mention that in a recent AAHA audio conference (3/7/06), the suggestion on vaccine protocols for NORMAL animals was to do the puppy series (not to begin prior to 6 weeks of age, vaccines to be given every three to four weeks; the suggestion was 8, 12 and 16 weeks, and they advised that at least 2 vaccines be given from 12 weeks on; hence, not 6, 9, 12), then boost everything one year later. After that, the "core" vaccines - distemper, parvo and adenovirus - would drop to a three-year protocol, unless otherwise indicted by titers. Rabies vaccine should be given as required by law in your area. Things like leptospira and bordatella will need to be boosted yearly in most at-risk animals, but not all animals are at risk for those, so let your vet advise you. Titers were felt to be most useful for adenovirus, parvo, distemper and rabies. It appears based on evidence that there is excellent correlation between the titer levels and the level of protection the dog actually has. Titers in recently-vaccinated dogs (such as pups finishing their series, for instance, or dogs being boosted because titers showed a loss of immunity) should be done no sooner than 2 weeks following the last vaccine. If good levels are not detected, re-test in 2 weeks. If good levels are STILL not detected, revaccinate (in case lingering maternal antibody blocked the vaccine or some other event occurred to prevent the dog from being properly immunized.) Rates of non-responders (as in, will NEVER produce immunity to a particular agent) were given as 1/2000 for parvo, and 1/5000 to 1/10,000 for distemper. (A given dog would NOT be expected to be a non-responder for both diseases - either/or.)

Hope that makes sense to all. I think you can also get the AAHA guidelines if you want to read them. Ping me if questions.

[Dal & Mad's Mom]

Ak Dog doc how old do they recommed the dogs be before skipping and titering? Jewel got the heck vaccinated out of her when she was 9 months so I skipped a year I was planning to vaccinate Dal again and jewel as we will have the puppy. Is it safe then to wait the 3 years on Jewel? Should Dal get a 2 year old set?

I did the every 3 year educated guess thing with Kirby after his 3 year shots but, he didnt really go anywhere.

[AK dog doc]

After the full series of puppy vaccines, they should be boosted 12 months later - regardless of what age they were when the "puppy" series is given. For most dogs, who get their puppy series completed by 4 months of age, that means they should be boosted about 16 months of age, more or less. For a dog who got the puppy series late, like say 6 months old, they should be boosted at a year and 6 months. If they got their first set of paired vaccines (two vaccines of the same type given 3 to 4 weeks apart, and occuring after 12 weeks of age, ie, the "puppy series") completed at a year, they should be boosted at two years. After that they should go to the three year unless there's a reason why not (and in some cases, as stated above, there IS a reason why not.)

SO: puppy series, then 12 months later boost everything, then go to a three-year (except as noted above for certain exceptions: poor responders, high exposure risk, certain agents such as bordatella and leptospira, titers below protective levels, or guidelines required by law as for rabies.) Is that making sense? And as always, I can't see your dogs, so be guided by those who can, and remember that titers are safer than guessing.

[Carson Crazies]

Thank you so much AK Dog Doc for all of the wonderful information! I'm going to print it out so I can sit down and pay close attention!

[Pipedream Farm]

AK Dog Doc,

it is my understanding that the viral vaccines give much longer protection than the bacterial vaccines; is this correct? If so; that makes vaccination interesting since many are combinations of viral and bacterial.

BTW, come on down and we'll make sure you get your fill of working your dogs on sheep.

Mark

[Dal & Mad's Mom]

Thank you ak dog doc

I like my current vet but, I know he is not on board with titers. I may look for another vet in the future.

[AK dog doc]

Mark, right on both counts (now, why am I not surprised...?) Fortunately, there is a viral combination vaccine offered without lepto (which in this area is not a big issue, but for dogs that travel, it might be). Bordatella is given as a single agent. There are different lepto serovars, which do not have good cross reactivity between them as far as the vaccines go. So, if you have a dog at high risk for lepto, the advice is to use a lepto 4-way (which is a 4-way for the different LEPTO serovars, not for anything else). Lepto is a re-emerging disease, as a BTW, because people stopped vaccinating for it, so if you live in a high-risk area (ask your vet), it's probably a good idea to vaccinate yearly for that. If not, the need is less pressing.

And be careful what you wish for... I might just take you up on that invite one day (probably not right away, though, so you're safe for now!) Can I bring the BF? (Hmm, maybe he should fly us down in the 180!) His dog is twice the stockdog mine is, I fear. (Sigh.) But I adore her, so I don't mind so much! (Maybe I should trade wine for orphan lambs...)

Sheryl, I guess your choices are to try to talk your vet into it or to try to find one more in sync with your preferences. If you like your vet, maybe requesting (coaxing, cajoling, bribing) them to try titers would be worth the effort? Your call.

[Eileen Stein]

I'm going to move this to the Health & Genetics forum and sticky it for now, and maybe move it to the FAQ once everyone has finished posting.

Thanks everyone, especially AK dog doc!

[Smokjbc]

Thank you ak dog doc

I like my current vet but, I know he is not on board with titers. I may look for another vet in the future.
>>> Sheryl

Hi,

Just wanted to say I agree with AK Doc about talking to your vet about it first. However, if you really trust your vet and feel he/she is medically sound- I wouldn't leave them over this. Even if he doesn't completely agree with doing titers vs. vaccines- you can still have him do it (if he uses the main labs, the only thing he has to do is draw the blood and send it). We have lots of clients who do things differently than we recommend vaccine wise or other health care wise. Most vets will, especially in the "information age" that we are in now. Clients are better educated than they used to be and we cater to what they feel is best for their dog (without compromising medical care). Give your vet a chance to work with you- but IMHO there are FAR more important things to worry about like diagnostic skills and just the ability to get sick pets better. Not all vets are created equal in those capacities and if you found one that is good under pressure and in difficult medical situations- keep her/him. I've worked with a vet who recommended titers whom I wouldn't let touch one of my dogs with a ten foot pole. Not that would be representative of vets who use titers, of course- but just to say I wouldn't give up a good vet over this.

[Lunar]

AK, thank you so much for all that information!! That was extremely helpful.

I'm wondering if anyone has a link to an explanation of why 3-year is recommended (in absence of titers)? I know you explained that it's more or less a "best guess" type thing - but I'm interested in seeing how they came to arrive at that number.

[Miztiki]

What is IgG and what does it mean if it's elevated?

[AfterThought]

I have a dilemma. My dog's annual vet visit is next week and I had wanted to do a titre test instead. But we are going away next month and he needs to be boarded and they require up to date vaccinations (including parvo, distemper).

[Carson Crazies]

AfterThought, here is what happened when we went. They took the blood, and sent it off to their lab to have titers run. A few days later, they called me back, and said everything was just fine --- and then they changed her records to say that the vacc's were due NEXT year. Ergo, her shots were now current as far as my vet and their paperwork was concerned.

Call your vet and see how this works for them, and hopefully they can clarify and give you peace of mind.