Vaccine-Preventable Infections & Your Vaccine Plan

We're so excited to continue our Good Breeder Webinar series with Dr. Trisha Rettig, PhD! This webinar is all about Vaccine-Preventable Infections and building a vaccine plan for your dogs. Watch the recording of the webinar now! The transcript will be added shortly.

Check out these additional slides from Dr. Rettig.

Transcription

Dr. Trisha Rettig [0:01] Judi already gave me a little bit of an introduction, but I’ll just kind of add to that a little bit. I got my PhD in immunology. I have had space mice. We had the first mice that were ever vaccinated aboard the International Space Station. That’s kind of my background. When I am not busy being an immunologist, I’m a dog enthusiast. I have a Pembroke Welsh Corgi and a Golden Retriever, which you guys heard about. They are enjoying and not enjoying the snow here in Chicagoland. I am active in multiple dog sports, and I am also a professional dog trainer. In this presentation, all the opinions here expressed are my own and not necessarily those of my employer. 

[0:47] If you attended my first webinar, you saw this already. The whole premise of this talk is that vaccines are important. However, it must be noted that I am not a DVM. Please work with your veterinarian to figure out what is the best situation for you. I’ll emphasize that throughout this presentation. Finally, I’m going to point out that I’m presenting this from the viewpoint of an immunologist rather than that of a veterinarian. The viewpoint may be a little bit different than you’re used to hearing from your veterinarian. 

[1:22] Today we’re going to go over some vaccine basics. A lot of this will be review from the first webinar, which you guys can access if you have questions about some of the stuff more in-depth. We’re going to talk briefly about the types of vaccines. We’re going to talk about monovalent and multivalent vaccines. And we’ll talk a little about herd immunity. We’ll also talk about vaccine-preventable diseases, so I’ll cover some core and non-core vaccinations. And then we’re going to spend some time on determining your protocol. 

[1:57] Vaccine basics. Again, a lot of this is going to be covered more in-depth in the first webinar, but I wanted to refresh your memory. I wanted you to hear it a second time so that way we have a solid basis for what we’re going to talk about, continuing on. 

[2:13] This is the immune response to a vaccination. It takes place over about 2 weeks. We start by injecting the vaccine. Vaccines are full of what we call antigens. These are then released into the body. Antigens are essentially parts of whatever infection we’re trying to prevent. Sometimes these are whole bacteria or whole viruses. Sometimes they’re a part of just the organism itself. Sometimes it’s just something on the surface. When we do the injection, the first cells to arrive are our innate immune cells. These cells sense that there’s an invader in the area, and some of them can fight pathogens by gobbling them up and digesting them. Some of them gobble up these antigens and then present them on their surface, and these are called antigen-presenting cells. Our innate immune cells can also help recruit other cells to the area. These antigen-presenting cells are able to transport themselves and their antigens to another part of the body. In this case, we’re going to look at lymph nodes. Any sort of secondary lymphoid tissue can do this. Our antigen-presenting cells and our antigens travel to the lymph nodes. Here they meet up with our adaptive immune cells. These are B and T cells. These are the cells that are specific for whatever antigen we’re looking at. Innate cells are general responders. Our adaptive cells are antigen-specific. These cells are able to communicate with each other. The adaptive cells are able to be activated, and they can leave the lymph nodes to travel throughout the body. They also produce a specific type of these called B cells, produce antibodies (which we’re going to talk about a little bit more), and these are also about to leave the lymph node. So, these cells are what are actually mounting the strong immune response to the vaccination. And then some of these adaptive immune cells are able to bind to antigens directly.

[4:22] So just briefly: Innate immune cells arrive at the injection site. Some of the cells travel to the lymph and blood systems, to lymphoid organs. We talked about lymph nodes. These innate and adaptive cells interact. The adaptive cells multiply and are activated to respond to the challenge. These are what help you fight the infection. And then they can also differentiate into what we call effector and memory cells. Effector cells are the short-lived ones that help you fight the infection, and then they die afterwards. The memory cells are long-lived, and they help you build immunity. This is what prevents you or limits your chances of getting reinfected by the same antigen. This is the general basis of immunology. This is why we get vaccines. This is why vaccines are important: to build these long-lasting memory cells to prevent our animals from getting sick. 

[5:20] So we’re going to talk briefly about the types of vaccines. I am going to mention these when I talk about the specific diseases, so it’s important to hear it again. We have attenuated vaccines. These are usually called modified-live or avirulent-live. These vaccines mimic a natural infection. These viruses (usually) are able to replicate within the body without really making you sick. You may feel sick from mounting an immune response, right? So a lot of the things that we feel like “sick” (fever, lethargy) are just your immune response responding. They’re able to do this for us. We’re able to achieve high levels of protection with these modified-live vaccines. We also have inactivated vaccines. These are vaccines where the organism has been killed, usually whole inactivated pathogens. These pathogens are unable to replicate after infection, and they may be associated with increased vaccine reactions. 

[6:29] Some of our vaccines are recombinant vaccines. We aren’t seeing a ton of these yet in the dog vaccine industry, but we see a lot more of these in the human vaccine industry. This is where a specific part of the virus or bacteria are transferred into a different virus or bacteria and we’re able to then give those. Those are, a lot of times, able to replicate naturally. This allows the specific antigen that we want to be presented without needing the original whole virus or bacteria. We also have toxoid vaccines. These are inactivated toxins. They’re really uncommon in dogs. The only one we have is the rattlesnake vaccine. We see these in humans as both tetanus and diphtheria; they’re examples of toxoid vaccines. 

[7:25] You may have heard the terms monovalent versus multivalent. A monovalent vaccine has only one strain or pathogen. For example, our rabies vaccine. When you get a rabies vaccine, it is only for rabies. If it’s bivalent, it has two strains or pathogens. For example, the canine influenza vaccine can protect against two different strains of canine influenza. And then we have multivalent. These protect against multiple strains or pathogens. For example, the lepto vaccine is multivalent. It protects against four different strains. And then we talk about our combination shots, and we talk about 3-, 5-, 7-, or 8-way vaccines; those are multivalent. 

[8:15] I’m going to give you a brief rundown of some of the vaccines that we have, so the core vaccines and the non-cores. What this is going to be is a brief overview of what these diseases are, what the infections are, what we’re seeing, and what the vaccines are. We’ll give you guys access. I have a more in-depth version of this, but I figured only three people in the world would be interested in it, so this is the scaled-down version. We’ll also give you guys access to the larger version that has more data behind it. 

[8:52] We’re going to start with our core vaccines. 

[8:55] Rabies virus. Most people have heard about this in the US. It’s a neurological virus spread by bites, saliva, or blood from infected animals. It has near 100% fatality. The only survivors that we’re able to find were some humans, like a few. So, basically 100% fatal. It’s transmitted mostly by wild terrestrial animals in the United States—mostly raccoons and skunks, but depending on your location, also foxes. We can see over here that along the coast, we have a lot more raccoons, but when you move throughout the country, you start to see a little more of the skunks giving it. We tend to think of bats giving rabies, but it isn’t necessarily super common in dogs, to see this. The vaccine is a killed virus vaccine, so it’s not able to replicate within the body. The downsides to rabies is it is the most commonly associated with vaccine reactions. This data is looking at vaccine reactions within the first three days after vaccinations in dogs weighing less than 99 pounds. We can see that a lot of these reactions are coming from the rabies alone. This is if we look at all vaccines, this is if we look at rabies alone. It is associated more commonly with vaccine reactions.

[10:30] I wanted to touch briefly on the rabies challenge study. This data should now be fully available for everybody, and we can send out the link for how to access that. I wanted to talk about this briefly, because a lot of people have heard about it. What this was is they vaccinated dogs with the rabies vaccine at 12 weeks and 15 weeks. There were some complications in the study, which I’m not going to go into (you guys can look at that) but of the data that they were actually able to get, all dogs were able to generate an antibody response, 6 years and 1 month after their original vaccination, so these dogs were able to respond to a booster that far out. However, when they challenged the dogs with live rabies virus, we see that over time, immunity wanes. So 6 years and 7 months after the original vaccination, when challenged with live rabies, only 80% survived and after 7 years and 1 month, 50% survived. And at 8 years, 20% survived. The original hope was that this study would show that we really only needed one rabies vaccine for life in our dogs, and that’s not true. This data shows that we do need to stick within the re-vaccination time gap. They’re working on trying to figure out where exactly this is. We do need that rabies booster every three years. I want to make sure that people are really thinking about giving this vaccine. Number 1: It is required by law, and there are some pretty stiff penalties if your dog bites somebody, is in contact with this, if they aren’t up-to-date on their vaccine. If you’re choosing not to give a lot of vaccines, this is still one that we really need to be careful of. Even depending on wherever you live, there are still a lot of possibilities for you to come in contact with rabies. Raccoons are pretty ubiquitous. We see them in a lot of places. We need to make sure that we’re keeping up on these, and that 3-year booster is supported by data now, at this point in time. 

[12:56] Next I wanted to look at distemper. This is an airborne virus that attacks the respiratory, gastrointestinal, and nervous systems of the dogs. It’s transmitted through airborne exposure but also shared food and equipment and contact with wild animals. This is important to know: it’s not just dog to dog transmission. It’s also from wild animals. It’s often fatal, and even if the dogs survive, they can have long-term damage to their nervous system. Many wild animals can carry distemper and local raccoons can put the dog population at risk. There isn’t a lot of overall tracking of distemper across the country, but LA (the county itself) looked at cases of distemper just in raccoons. You can see this isn’t a trivial number of raccoons in LA that have distemper. It is still out there! It’s still something we’re seeing, and you’re not necessarily safe because your dog is not coming into contact with other dogs or whatever. Those wild animals can carry it, and you can see spikes in dog cases if the local raccoon population has a lot of it. We did see a new strain introduced in 2019. It came into Canada from Asia. It’s not unlikely that it will eventually make its way to the US. In the United States, we have a modified-live vaccine, but there are some available recombinant vaccines for non-US. It is usually part of a multivalent vaccine, so you usually see this as part of your 3-ways or 5-ways. Vaccination with the distemper vaccine can cause a brief period of immunosuppression from days 3-10 post-vaccination. This is because of the body’s natural response to canine distemper. The virus itself causes immunosuppression to be able to replicate within the body. This is a normal immune response. When we give the modified-live, it causes a very brief period of immunosuppression. It is unlikely to cause any clinical problems, but it’s suggested that you not give other vaccines during this time so that way your dog has the ability to properly respond. 

[15:32] When we look at adenovirus, there are two strains that are antigenically similar. We mentioned before that antigens are what the body can respond to, so these two strains are very similar in that the body can respond to them in similar ways. CAV 1 is multisystemic and causes liver failure and does have mortality rates from 10-30%. CAV 2 is associated with upper respiratory infections and lumped under the group that’s considered “kennel cough.” Animals can carry and shed the virus, despite having high antibody levels. Even if your animal may be vaccinated, they can still carry it to other animals. Distribution is not well-tracked, but when looking at upper respiratory infections, CAV 2 accounted for about 2.5% of those seen in one study, so this is out there and they are circulating. They are a modified-live vaccine, and you can vaccine against CAV 1 and CAV 2, or you can just vaccinate against CAV 2. The research right now prefers to target just CAV 2, because CAV 1 vaccines have produced some opacity of the cornea. Usually it’s transient. But it can also cause viral shedding in the urine. If possible, you can vaccinate just against CAV 2 and be protected against both. 

[17:11] When we look at parvo, these infections usually target the GI tract but in puppies less than 6 weeks, it can also cause heart issues. This is the leading cause of death among young animals, among young dogs. The mortality rate is greater than 90% and is particularly lethal in puppies less than 6 months. It can be transmitted by contact with feces, vomit, saliva, or contaminated food or water. Parvo is particularly difficult because it is a hardy virus that can survive outside of the animal. It can be difficult to disinfect. It can be stuck in the dirt. It can get stuck into the ground and live for a while there without an animal host. And infected animals shed very large numbers of the virus. We use a modified-live vaccine, and it is a highly efficacious vaccine, meaning that most animals respond to it, and you can grant protection as soon as 3 days post-vaccination. In a lot of cases, a single, properly-timed vaccination may be enough to provide immunity for life for our animals. This is a very good vaccine. 

[18:25] Cases are still common and outbreaks are still considered endemic in some areas. We tend to think of parvo as a shelter disease, so it runs rampant in shelters, but it’s not out in the general public. Again, LA County has done a very good job of tracking these things, and when they looked at cases in their animals, 90% of the cases were acquired in the community. They weren’t just looking at “it got into the shelter, and then the shelter couldn’t get rid of it.” A lot of these are community-acquired infections. Recent data shows that we’re seeing a lot of this now with Covid. People weren’t necessarily getting preventative care that they should have. It’s been tough to get into vets. Even for just normal things, it’s been tough to get in. So perhaps people are putting off these normal preventative cares, and we’re starting to see an increase in parvo, which, when we start to see increases, obviously that affects the rest of our animals. 

[19:34] Now we’re going to talk about the non-core vaccines. 

[19:39] The first one we’re going to talk about is kennel cough. This is kind of a lump-all term for a lot of upper respiratory infections. This includes canine parainfluenza, bordetella bronchiseptica (a bacterium), CAV 2 (which we talked about earlier)—but it also includes other general upper respiratory infections that cannot be covered by vaccines. When we talk about the kennel cough vaccine, usually a bordetella vaccine, it can include the parainfluenza and also the adenovirus vaccine. The disease is usually mild, with a dry cough and most dogs recover within a few weeks. But in some cases, this can lead to a secondary infection. The secondary infections are more traumatic to the animals. The vaccine comes in multiple forms. The preferred route is either oral or intranasal. These are either modified or avirulent-live (modified-live is used for viruses; avirulent-live is used for bacteria). This is the preferred route. We also have injectables, which can be inactivated, killed, or modified-live as well. Vaccine immunity is relatively short. It’s recommended that vaccines are given every 6-9 months in at-risk populations (kennels, if you have a dog that goes to daycare, shelters, dog shows). Studies are showing that asymptomatic dogs are also able to test positive for these viruses and bacteria. So even if your dog doesn’t look like they have kennel cough, they’re still able to carry it. One study looked at 43.3% of dogs with parainfluenzae infections had been previously vaccinated. This study did not look at the time from vaccination to infection, so it’s possible that those dogs were vaccinated a long time before they got their infection, but it shows that this isn’t necessarily a highly efficacious vaccine that’s providing a lot of protection for a long time. 

[22:00] Leptospirosis is a big one. I tend to get a lot of questions about this. Lepto is a catch-all term for infections caused by the leptospira genus. There are over 22 species and over 250 serovars. A serovar is a variation of that same bacteria. It’s the same type, but it looks a little different. It’s kind of like a little different strain. It is a zoonotic infection, meaning that it can infect people. It affects the kidneys and may cause liver damage. When we look at this, this graph shows positive lepto tests from 2000-2014, so we can see that it does tend to be more common in specific areas. It does like warm, moist environments. But it is present throughout the country. Treatment is usually successful but damage to the kidney and liver may be permanent. It is spread through urine, placental fluids, or milk of infected animals, usually contaminating a water source. This can be wild animals or farm animals, but we tend to think of it also as rodents. If you’re out in the woods and there’s rodents everywhere, they can spread lepto. The vaccine is an inactivated tetravalent whole bacteria vaccine, so this is covering against 4 serovars. You can get vaccines that cover less, but the traditional is 4 serovars. They cover the common ones found in dogs, rats, skunks, raccoons, and other species. These are trying to protect our dogs from the most common ones. Immunity to the dog serovar lasts about 13 months, so this vaccination needs to be repeated every year. 

[24:00] For the dog flu (canine influenza), this is an upper respiratory infection where many dogs also have subclinical infections. The mortality rate was between 1-5%, and it also can infect cats. It’s transmitted through airborne droplets, contact with other infected dogs, or their items, which includes humans. This can travel on humans from dogs to dogs. We have two strains circulating in the US: H3N8 (which came in 2004) and H3N2 (which came in 2015). Both strains are actively circulating throughout the country, and H3N2 outbreaks were seen in 2019 in the Bay Area, Sacramento, Southern California, and Portland. In my experience, this has kind of faded from people’s minds after the big 2015 scare, but it’s still out there and still circulating and still causing outbreaks. We have a bivalent killed vaccine that is good for both strains, and it is currently given yearly as the duration of immunity has not been well-established. 

[25:14] I want to take a moment to really talk about the dog flu outbreak. As I’ve mentioned, I’m in Chicago now, which was kind of where this all started. This one hit really close to home, and I have friends’ dogs that were infected by it. We start to see this happening—March 14 is when it really started to break out. This chart is looking at cases from March 14 to April 27. We can see how quickly this rises, right? We’re seeing 150 cases within just a month. When we look at cases from March to December, we can see how this traveled around the country. It didn’t take long. We don’t necessarily need this reminder right now—while we’re in the middle of Covid—but it gives us an idea even with our dogs. They can’t get in their cars and drive. This is all people moving them around. So how quickly this spread around the country and how severe it was, in some cases—it can take just one infection to really start this problem across the country, including in our animals that we have to transport everywhere. It is still circulating right now, as we can see. These are cases from 2015-2018. It’s still circulating around the country. Some areas were bigger hot spots than others, but this is still something that’s ongoing, even though it’s kind of faded from a lot of people’s minds. 

[26:51] The final one I’m going to talk about is lyme’s disease. This is caused by borrelia; it’s a bacterial infection. It’s a spirochete, so it’s a specific type of bacteria. Lyme’s disease is kind of a tricky one. It’s pretty regional. There’s definitely some really dense areas of it. It is notoriously difficult to diagnose. The symptoms, a lot of times, are general so things like lethargy, fever, just not doing right. The diagnostic tests aren’t always 100% reliable. They can require multiple tests. Chronic infections and symptoms are possible. The treatment is long-term antibiotics. It is found in all 50 states but is most common in the Northeast and the Upper Midwest. The vaccine available is a killed or recombinant surface protein vaccine. Use of the vaccine is currently debated in the veterinary community. Looking at both sides, lyme’s can be serious and fatal, but some supporters believe that vaccines are very effective and they have low levels of reactions. It’s also considered easy to treat and tick prevention is pretty easy for our dogs. They also say that vaccines can have variable efficacy and require yearly retreatment. The OpsA (which is a component of the vaccine, so this is part of the outer-coating of the lyme’s bacteria) is associated with lyme’s, arthritis, kidney issues, and other common lyme’s symptoms. Use of the vaccine is kind of up in the air in the community, but these are some of pros and the cons to it. 

[28:45] We also have rare and not-recommended vaccines. One of them is the coronavirus. We do have a vaccine for giardia and, finally, rattlesnake venom. I’m not going to talk about those. They are available. Corona and giardia are not recommended and the rattlesnake venom is obviously only for very specific parts of the country. Again, vets are kind of up in the air about using or not using it. 

[29:12] Given all of that, how do we build our vaccination plan? Building on the previous webinar in this webinar. It is essential that you vaccinate animals that are able to be vaccinated. This is just a fact. It is important that we are able to protect animals. 

[29:39] I wanted to talk briefly about the importance of herd immunity. This is why it’s important to vaccinate the animals that we can vaccinate. If enough animals are protected, outbreaks of infectious disease are limited. It’s usually about 70-80% immunity is able to provide infection control and really limit the spread of these diseases. Decreases in vaccinations lead to outbreaks. It is imperative that we maintain high levels of vaccination to prevent outbreaks in relatively well-controlled infections. For example, when we look at measles cases, we can see that the vaccine was licensed in ’63. Once we were able to start getting people vaccinated, we basically see no cases of measles, right? They start to disappear. However, starting in the 2000s, we started to see this rise of people who are against vaccines and choosing not to vaccine, and now we’re starting to see an increase in measles cases. We aren’t up to our pre-vaccination levels, but we’re starting to see this increase trend in measles cases again as we start seeing a decreased level of measles vaccination. This is an example of how herd immunity works. The blue dots are people who are not vaccinated. The yellow dots are people or dogs who are vaccinated. What we’re going to see is, hopefully if the video works—you can find this online. I’ll try to make sure that we include a link to it, so that way you guys can actually play it. The infections run rampant through the unvaccinated populations. We’re seeing this right now with Covid-19. We’re experiencing this in real life. Once we’re able to reach a 70-80% vaccination level, it prevents. It provides these buffers for the people that can’t be vaccinated to still be protected. That way, we’re able to isolate the infection and keep it from spreading further. This is what we’re really trying to do. This is why herd immunity is so vitally important. 

[32:12] I wanted to talk again about nomographs and titers. There’s some more talk about it in the previous webinar, but what these are is a titer determines the antibody levels in the blood to a specific infection. The company that’s providing the titer can tell you if the dog is immune or not immune. Titers are simply an immune/not immune test. A higher titer number does not necessarily mean that the dog is more protected. You’re protected or not protected. Nomographs are what we can do; we can test our bitch’s blood and find out what our bitch’s antibody levels are, and we can use these to figure out when the best time is to vaccinate our puppies. If we vaccinate too early, mom’s antibodies are going to prevent the puppies from mounting their own immune response. When we just start picking dates to vaccinate—6, 8, 12—that doesn’t necessarily mean that mom’s protection has worn off. This gives us an ability to time our vaccines so that we know that our vaccines are actually being useful. I suggest you check out CAVIDS and also Avidog for more information. Avidog has a free e-book and also an amazing webinar. I can’t remember how much it costs, but it’s not that expensive. That kind of goes through how to do these nomographs. Nomographs are not expensive. You run them at the University of Wisconsin–Madison at the CAVIDS lab. I strongly suggest that people be doing this. 

[33:54] Given that, what are our current recommendations? So, the World Small Animal Veterinary Association and the American Association (I can’t remember all their letters)—the vet areas that cover the US—for modified-live or recombinant vaccines, the current recommendations are to give a puppy series, to give a booster (6-12 months later), and then every 3+ years after that. They recommend annual vaccinations for bacterial and killed viruses, except for rabies, which we obviously can give 1-year or 3-year rabies. Both organizations are now discussing the use of titers when making vaccine recommendations. For a long time, there was kind of this “we don’t really know about titers.” But it’s definitely become more common, and you’re starting to see more recommendations for these. So if you have a vet that is perhaps pushing back against wanting to titer at 3 years, you can suggest that they go to these now and that these recommendations are being discussed. 

[35:07] What are some considerations for your plan? How old is my dog and what is their previous vaccination history? You should run nomographs for your puppies. You should be running titers for your adult dogs to determine their current immunity status. Do I need to vaccinate at this point in time? What’s my dog’s home lifestyle? Are they exposed to wildlife? If so, what types? Remember: just because you live in a city, doesn’t mean there isn’t wildlife around. Rodents, everywhere. Raccoons, everywhere. Possums, everywhere. Even if you live in a city, you’re not necessarily fully protected from these. Are my dogs exposed to farm animals? What may those farm animals carry? What exposures does my dog have outside of the home? Are you going to shows? Are you going to daycare? Do they spend time in boarding kennels? Are you traveling to areas that have a higher risk of specific diseases? What about ticks? Are you using tick control? How does that play into what my dog is really at risk for? 

[36:17] Realistically, we have to make some decisions about what are the risks if my dog does become infected. What are the chances associated with survival? What are the costs? Can I afford to save my dog if they get infected with this? Is the infection zoonotic? Is it highly contagious to other dogs? Will I put other dogs (either in my home or in my community) or people at risk if my dog gets this disease? Does my dog’s breed or heritage have any effect on my vaccination plan? Some breeds are notorious for being non-responders. If I give a vaccine, I need to make sure, if I don’t follow that up with a titer, to make sure that the animal is actually covered. Some lines are known for vaccine reactions. Is that going to play a role in, perhaps, how I stagger everything? We also know that smaller breeds are more likely to have vaccine reactions when challenged with multiple vaccines. If I have a small dog, I may want to consider spacing out vaccines more than if I have a large dog. 

[37:22] What is my dog’s current health status? Vaccines should only be given to healthy individuals. We see sometimes vets want to push, like “Oh, your dog’s in for their spay surgery. Let’s do their vaccines.” We shouldn’t be giving them to sick animals, animals that have parasites, animals with other things going on. If they’re going in for even something like a dental, this is still already something that’s going to activate the immune system, so we should give vaccines only to healthy animals when they are fully active. And also is activating the immune system a good idea? If you have animals that have autoimmune diseases, is it a good time to be giving that vaccine? Finally, what does my vet recommend? A trusted vet is obviously irreplaceable. You should be speaking to them regarding your concerns, questions, and also to get an idea of what the local population actually looks like. How many cases of lepto are you seeing? How many cases of lyme’s are you seeing? As I’ve kind of alluded to, we’ve lived around the country. Lyme’s is a worry when I’m up in the Midwest, but when I was in SoCal, where I saw one tick in two years, maybe it’s less of a concern then. Your vet will have a good idea of what the actual risks and populations are for your area. 

[38:55] Finalizing your plan: your goal is to fully protect your dog for their lifestyle while minimizing the total number of vaccines and reactions. Use nomographs and titers to determine what vaccines are needed and when. Limit the number of antigens presented at once. Consider avoiding excessively multivalent shots. Do I need a 7-way or can I give a 3-way and pack additional vaccines on later? You should provide at least two weeks between vaccinations whenever possible. You should consider external factors regarding disease exposure. Consider your dog’s specific health state. Again, speak to your veterinarian regarding plans and decisions. Again, I just wanted to point this out: dogs with lower body weight, the number of vaccines given increases their chances of having an adverse event. Those of you, especially with small dogs, should consider how we can really space those out. 

[40:00] With that, I will take questions. 

Dr. Judi Stella [40:09] Thank you. That was great! We do have several questions. One of them, I know we touched on a little bit in the last webinar, but can you speak again to the vaccine dose because we still have concerns about small dogs and giant breeds getting the same dose—can you speak a little about that? 

Dr. Trisha Rettig [40:26] So, your body—to mount a proper, efficient, long-lived response—needs to have a specific level of exposure. That’s what those vaccines are designed to do. When vaccine manufacturers decide the dose, they aren’t just throwing darts at a dartboard. They do what’s called a dose-dependent response, so they measure in the animal: What does this dose do? What does this dose do? What does this dose do? How can I provide effective vaccination across the board and effective protection for these animals? What dose do I need to administer? That dose is dependent on the immune system itself. This isn’t like a drug that’s dependent on the body size. The immune system needs to hit a certain amount to respond properly. It is imperative that full vaccine doses be given, because that is based on immune activation, not based on the size of the animal. 

Dr. Judi Stella [41:35] This is an interesting one. What is the length of immunity conferred? Do we know this, by an actual bordetella or parainfluenza infection? Does the dog need to be vaccinated again if they’ve had the disease? 

Dr. Trisha Rettig [41:50] I have absolutely no idea. I don’t know if we know that. I did not find that in my research. That doesn’t mean it doesn’t exist. It just means I wasn’t looking for it. 

Dr. Judi Stella [42:00] It’s a little tricky, too, because the symptoms are going to be the same and so you’d have to know exactly what it was infected with to determine which vaccine you would not give if they did have life-long immunity, correct?

Dr. Trisha Rettig [42:12] Right. Bordetella is killed, so generally, modified-lives and “real infections” confer longer immunity. That’s not universal. That’s not guaranteed. I have no idea. 

Dr. Judi Stella [42:33] Someone has a question. They’re getting a new puppy, and the puppy has no vaccines. Should we do a nomograph on the puppy or do titers? Again, can we just explain nomographs? Nomographs are done on the bitch, and the puppies get titers. 

Dr. Trisha Rettig [42:51] Correct. The nomograph looks at the bitch’s blood and how much antibody they were able to give to their puppies in colostrum, which is the first milk that they produce. That’s what we call passive immunity. Mom is giving immunity to her puppies. If you want to measure your puppy’s specific response, those are done with titers, and that’s looking at your animal’s specific response and what sort of immunity they have at all. 

Dr. Judi Stella [43:22] In this case, I would suggest being super careful—either finding out whether that breeder has done nomographs so you know when to time that puppy’s vaccine or get vaccinations to be on the safe side and do the recommended protocol. 

Dr. Trisha Rettig [43:38] Right, so if I was getting a puppy that I didn’t know the vaccine status of, I would probably titer, vaccinate, titer again—because that will tell you whether or not those numbers went up after the puppy got vaccinated. That will give you an idea of whether or not that puppy actually got protection. If you just titer and you see a number, that number may be mom’s number, right? You have to make sure that your puppy is actually being protected. And they aren’t expensive. Titers, I think, are somewhere from $40-$80, depending on where you get them done. They’re not expensive parts of caring for our pets. 

Dr. Judi Stella [44:22] For anybody who is interested in doing titers, we do have links to some labs that do titers, so that you can find out more information on our Good Breeder Center. We can drop that link in there in a little while. Okay, so somebody had a question about whether the distemper vaccine is effective against the new distemper strain. Do we know that?

Dr. Trisha Rettig [44:44] I don’t know about that. I don’t know why it wouldn’t be, given the data that I saw. I think it’s just a new strain, and it’s still able to protect against it. But I don’t know that for sure! 

Dr. Judi Stella [45:03] This one is interesting: We know that vaccines stimulate the immune system. She has a show Labrador, and they’ve been dealing with skin and ear issues, loss of hair, things like that. After a year of vets and dermatology, we switched food to raw. My question is: What if the dog has vaccinosis and any correlation with lupus and vaccines? 

Dr. Trisha Rettig [45:32] We talked about correlations between vaccines and autoimmune diseases in the first one. There’s not data to support that. Vaccinosis isn’t really a thing. You can have a reaction to a vaccine, and it’s also important to separate the idea of a vaccine reaction that’s something like anaphylactic shock, things that are true allergic reactions, versus things that we think of as a vaccine reaction: redness, swelling, lethargy, fever. These are normal immune responses. You get them when you get a cold. This is entirely normal. This is your body’s immune response fighting something off. While we tend to think of them as a vaccine reaction, it’s just your immune system working. Those things are all entirely normal and are signs of a healthy body. This happens, versus something like: my dog had hives, my dog went into anaphylactic shock. Those are perhaps true allergies and should be handled as true allergies. You want your animals to be healthy when you vaccinate them. Getting things handled so that way allergies can get under control and things like that are one thing, but vaccinosis is this idea of “my dog had a vaccine; now it is sick because it had a vaccine.” Does that answer where we’re going? 

Dr. Judi Stella [47:15] I think so. Why is the giardia vaccine not recommended?

Dr. Trisha Rettig [47:18] I also have no idea on that one. My guess is it’s probably not very effective, from the original reading, but I can do some more research. I will write it down in my notebook.

Dr. Judi Stella [47:38] Have you heard of fairly high deaths in toy dogs when given lepto?

Dr. Trisha Rettig [47:47] I have not. I have heard anecdotally that a lot of dogs seem to have responses to the lepto vaccine. I do not have any data to back that up except my own personal experiences with it. I wasn’t able to find anything specifically linked to death or reactions as far as studies go, so I can’t speak to that scientifically, but I can say anecdotally that I have seen more vaccine reactions to lepto than perhaps some of the other ones. 

Dr. Judi Stella [48:23] This one’s interesting: I have a 13.75-year-old that is due for rabies vaccination. How can I minimize her risk when she gets her vaccine? 

Dr. Trisha Rettig [48:33] We can’t minimize risks to the vaccine in and of itself, except to not give the vaccine with other vaccines. Some states actually do now allow rabies titers to not have to give your rabies vaccines. I don’t have that list off the top of my head, but that may be something you choose to look into for an almost-14-year-old. Basically just making sure that your dog is healthy, especially at that age. I would want to make sure that I have blood work ahead of time. Are kidney values normal? Are liver values normal? What can we do to make sure that our dog is safe? Additionally, I would also make sure that I’m giving the 3-year rabies vaccine, so that way I’m not having to challenge my dog every year with this vaccine. 

Dr. Judi Stella [49:30] A question about titers: They may not need to be checked every year, and are vets beginning to accept titers as opposed to yearly vaccinations? 

Dr. Trisha Rettig [49:42] The current recommendations from the WSABA and AAHA (a bunch of letters) is you check titers every 3 years. I would check at 3, make some decisions based off of that as to when I need to continue to re-check. I, personally, have been able to find veterinarians that are willing to work with me regarding titers. I’m starting to really see that come around. In the national organizations, they’re starting to come around to that as well. They seem to be much more universally available than they were. My Corgi’s almost 9, and 9 years ago, it could be hard to find titers, but now they seem to be more universally accepted. 

Dr. Judi Stella [50:31] That’s been my experience, too. It’s not been terribly difficult. Like I said, we have that information, so we can get some of those testing labs to you to facilitate with your veterinarian, if you would like.

Dr. Trisha Rettig [50:40] And you don’t necessarily have to send them out through your veterinarian. The last time I had titers done, I sent them out myself. I was able to go into my vet, request the amount of serum that I needed, and then I mailed it off to get my titers done. They usually don’t even need to be refrigerated. They can just go in regular mail. 

Dr. Judi Stella [51:03] We touched on this a little bit too, but: vaccinating females—how far in advance should that be done? We don’t want to vaccinate pregnant females. 

Dr. Trisha Rettig [51:10] Right. This one can be a little tricky. Obviously rabies is required by law. You need to make sure you’re doing that. If possible, it would be best to put your vaccinations after puppies go home. If we vaccinate our bitches two months before she’s due in season, her titer levels are going to be sky-high, which means when she goes to give colostrum to her puppies, their titers are also going to be sky-high. It takes longer for that to wear off, which means our puppies’ ability to respond to the vaccine is later. When it starts to get later, these can be out 12, 14, 16 weeks—after puppies have gone home. So these puppies are at this at-risk period when they’re trying to go home and people are trying to socialize before they can really get vaccines that their dogs respond to. The further away from your bitch’s breeding cycle—assuming you’re breeding that cycle—you can get them while still getting fully covered would be ideal. 

Dr. Judi Stella [52:22] Can you explain a little bit about the difference between a 1-year and a 3-year rabies? We talk about it like everyone knows, but that’s probably a good question. 

Dr. Trisha Rettig [52:30] To the best of my understanding, they are essentially the same vaccine. They are just rated differently. Some of them are tested for one year, so they test them to verify that the vaccine is actually working. They’re verified for one year or they’re verified for three years, but they are essentially the same vaccine. Different states have different laws, so some states require that you get a 1-year puppy and then you follow up one year later. Some states don’t have that recommendation. For example, Hubble (my Golden)—we vaccinated at 12-14 weeks, and then we waited a month. Then I was able to get his 3-year vaccine done right after that, so he was protected right away. I didn’t go back and do a 1-year then. Now his 3 years is coming back, and then we’ll go back and do a 3-year. 

Dr. Judi Stella [53:27] How do you measure the nomograph in the pregnant bitch? It’s, what, 2 weeks—

Dr. Trisha Rettig [53:30] At least two weeks before or after whelping. Preferably the closer you can do it is better, but I know a lot of people—when they go in for their ultrasound—they’ll get blood drawn at their ultrasound because they’re already there with their dog and it’s not another trip to the vet. That would be a perfectly fine time. If your ultrasound confirms puppies, go ahead. Draw your nomograph. Get it sent out. 

Dr. Judi Stella [53:57] Question about adjuvants: When the number of vaccine reactions is increasing with the number of vaccines, is it due to excess adjuvants or due to the number of actual antigens? 

Dr. Trisha Rettig [54:11] It would not be possible to separate that. However, part of the reason why we do see an increased reaction level to having to use killed viruses is because they require adjuvants. We do know that adjuvants increase the immune system. However, adjuvants in and of themselves are not bad. We talked about adjuvants a lot more in the first one, so you can go back and watch that, but there would be no way to separate that, whether it was adjuvant-caused or antigen-caused. 

Dr. Judi Stella [54:50] Let’s pick one more. I think we still have a little misunderstanding around the nomographs. Again, I encourage everybody to watch the first recording and, also, we have more information available about the nomographs. We have the Avidog book and the links to CAVIDS. 

Dr. Trisha Rettig [55:20] Avidog also has a glorious webinar. That goes more in-depth than this, so that’s why I didn’t go into a lot of it, because that data is already out there and is well-covered. I would highly recommend you buy that. 

Dr. Judi Stella [55:33] If the puppies’ titer is high due to the bitch being vaccinated, isn’t the puppy protected? Can you just explain how that works again? 

Dr. Trisha Rettig [55:41] Sure! So, when a puppy is born, they have no antibody levels. When they nurse, they get this colostrum from their mom. That mom’s colostrum has the antibodies that provide what we call passive immunity. Puppies are protected if they come in contact with, say, parvo. But they don’t have their own immune response, to be able to protect themselves. Once mom’s antibody levels fade, the puppies become susceptible. There comes a point where you lose maternal protection. Mom’s antibodies in the puppy are not circulating enough to provide immunity to those puppies anymore. They still have antibody levels, but they aren’t enough to actually protect the animal. There is a gap between this loss of maternal protection and when your puppy is actually able to mount an immune response. This gap here is where your puppies are at risk. They have some maternal antibodies, but it is too much to actually be able to respond to the vaccine. Basically, mom’s antibodies will gobble up all the vaccine, and the puppies won’t be able to respond. The goal is that this at-risk period is hopefully while the puppies are with their breeder. That way, it’s between 3-8 weeks, puppies are mostly protected. They aren’t out being socialized. Our trick is to find out when they’re able to mount that immune response, so that way we’re able to vaccinate. That’s what the nomographs do. Instead of just randomly picking 6, 8, 10 or 8, 10, 12—I’m not sure what’s all out there anymore—8, 10, 12, 14. We’re able to actually pinpoint it for these puppies in this litter, when it is safe to vaccinate them, so that they are able to respond. Depending on the vaccine (if we’re talking parvo/distemper here), a lot of times that’s one vaccine and your dog is good for a very long time. We talked about this in the first one; you can go back and see it. I showed my dogs’ titers. Again, my almost-9-year-old Corgi is just now at the point where she needs another vaccine, where she needs to be boostered for this. Being able to do the nomographs, to titer exactly—she received one puppy vaccine, and it took her 8 years to need another one. Using the combination of these nomographs (to be able to time our initial vaccine) and then using titers over the life of our dogs, we can limit the number of vaccines that we need to achieve full, healthy protection. 

Dr. Judi Stella [58:28] And the important part is you give that vaccine, and then you have to titer that puppy to make sure that you actually captured it. The literature does show individual differences, even within a litter. You’re just trying to get more in the ballpark, but you still have to individualize that and make sure that that puppy’s protected, make sure that you don’t have a non-responder in the group, and that they don’t need another booster. We all still need to work with our veterinarians to make sure that that’s happening. 

Dr. Trisha Rettig [58:55] Right, so you need to nomograph, vaccinate, titer. And make sure that that works. I have friends that have needed to give a second vaccine. Like, the dog came back protected against parvo but didn’t come back protected against distemper. We need to give it again to make sure that our dogs are fully protected. There’s a couple of steps in there. 

Dr. Judi Stella [59:16] This has been great! Thank you so much. I’m going to thank everybody for joining us. Thank you, Trisha, for doing this second webinar. If anyone has any additional questions that we didn’t get to, please just email us at help@gooddog.com. We’ll be able to get those answers to you. Just so everyone knows, we do have a webinar next Thursday at 1pm EST with Dr. Hutchinson, and he is going to talk about the stages of labor. We hope you will all join us for that. Be sure to register. My assistants here today have dropped that link into the chat, and we look forward to seeing all of you!