Vaccines: Risk versus Benefit

By Carla Webb, DVM
Contributing Author 

Introduction

Every time you make a clinical decision, it’s important to weigh the potential outcomes to help guide you down the most optimal path. This same scrutiny should exist when working with your clients to develop an individualized vaccine recommendation for each patient. When it comes to vaccines, there are so many benefits that we see as veterinary professionals; however, it is also just as important to weigh the risks involved.

Banfield has developed its vaccine recommendations as a result of a comprehensive product review and classified each vaccine as either core, standard or to be given based on risk. Core vaccines are recommended for all pets, standard vaccines should be administered to most pets, and non-core (based on risk) vaccines should be given based on an individual’s potential lifestyle and risk of exposure to each disease.
 

Table of Contents

 

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Thoughts to Consider

Every recommendation that is developed should include an assessment of each patient and each vaccine that is to be given. In addition to the health of the pet, several vaccines are recommended with the safety of the family in mind. Zoonotic diseases can be transferred directly from animals to people. As a practice, Banfield believes in vaccinating pets against the zoonotic diseases leptospirosis and rabies.
 

Consideration 1: Size, Breed, and Age of the Pet

First, you should consider the size, breed and age of the pet that is receiving vaccines. Some breeds are at higher risk of developing adverse vaccine reactions. The number one breed reported to have vaccine reactions outnumbering all other breeds was the French Bulldog. The second most common breed was the Dachshund, with all varieties and sizes represented (See Figure 1).

High-Risk Breed Vaccine Reactions
This should be a key step in evaluating the risk involved for each patient, but it is important to note that vaccine reactions are rare, even in these high-risk breeds. Vaccinations should not be declined or not recommended based on these slightly increased risk factors, especially in dogs that have never had a previously reported vaccine reaction.

Multiple-Injection Vaccine Reactions
In addition to high-risk breeds, small-breed dogs and puppies (<3 kg) have also been shown to have an increased rate of adverse vaccine reactions when multiple vaccine injections are administered in the same visit.2 Therefore, it may be suggested to limit the number of vaccine injections given at any one visit (combo vaccines count as one injection) or even complete the core vaccines prior to administering non-core vaccines, unless the dog is at high risk of contracting a specific disease.
 

  Figure 1: TOP 10 DOG BREEDS WITH ADVERSE VACCINE REACTIONS

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Consideration 2: Lifestyle and Risk of Exposure

Secondarily, you should consider the lifestyle and risk of exposure for each patient. Knowing the specific risk factors for each of the infectious diseases we vaccinate against is important to ensure we’re making the appropriate vaccination recommendations (e.g., Does the cat go outside often? Does the dog go to daycare regularly? Does the dog frequently go hiking or camping with the owner?)
 

Figure 2: Canine Infectious Disease Risk Checklist

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Figure 3: Feline Infectious Disease Risk Checklist

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Consideration 3: Disease Risks Based on Region

Regional prevalence of diseases can also be a useful means of determining whether an individual pet is at risk for coming into contact with a specific disease. It is important to review these different risks and benefits at each preventive care examination, as they may have changed over time.
 
  • See Figure 4 for a U.S. Map indicating Lyme Disease prevalence
  • See Figure 5 or a U.S. Map indicating Kennel Cough prevalence
  • See Figure 6 or a U.S. Map indicating Feline Upper Respiratory prevalence

Figure 4: PREVALENCE OF POSITIVE LYME DISEASE RESULTS IN DOGS (2012)

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Figure 5: PREVALENCE OF KENNEL COUGH IN DOGS (2012)

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Figure 6: PREVALENCE OF UPPER RESPIRATORY INFECTIONS IN CATS (2012)

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Consideration 4: Vaccine Discontinuation

Discontinuation of any or all vaccines may be based on a myriad of situations, such as a previous vaccine reaction, illness, pregnancy, immune-mediated disease or contraindication with current therapies. If you do make the decision to discontinue vaccination(s) you should identify if an alternate solution exists (vaccine titers) and what, if any, legal implications pertain to your decision (rabies vaccine).

If you or your clients decide that vaccinations are not the desired course for their pets, it is critical that the clients be appropriately educated. Specifically, the rabies vaccine is legally required for all dogs in all states with some states or counties having legal requirements for the vaccination of cats.

Clients should fully understand the legal ramifications of not vaccinating their pets for rabies should a bite incident occur, including quarantine and possible euthanasia.
 

Conclusion

Remember, the keys to infectious disease prevention are creating individualized vaccine plans for each patient, decreasing the possibility for adverse events, and client education. As always, the above considerations are best practice recommendations and are subject to a doctor’s clinical judgment. Partnering with your clients with an open line of communication and education on their pets’ individual needs will instill trust into your relationship and will help them accept your vaccine recommendations and increase compliance in all areas of preventive care for their pets.
 

Clinical Decision Support

Banfield’s quadrant chart can be used as a clinical decision support tool when performing a risk:benefit assessment. Figure 7 (directly below) serves as a quick-reference guide for weighing various risks and benefits when making a decision based on your patient's unique situation.

Figure 7: Clinical Decision Support Diagram

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References

1. 2012 BARK data. Banfield Research and Knowledge team. Portland, Ore.
2. Shearer P. Critically appraised topic (CAT): Vaccines. Banfield Journal. 2009;5(5):14-18.
 

About the author

Carla Webb, DVM, graduated from Oregon State University in 2010. From 2008-2010, she worked with the Banfield Student Jobs Program and externship program, and joined Banfield full time in 2010. Dr. Webb was a clinical veterinarian in Banfield hospitals in Oregon for four years and is currently a project manager on Banfield’s Medical Programs team. Dr. Webb lives with her husband, Chris, and a crazy Siamese named Miso.