If you’re a regular Dolittler reader you’ll know I’m a big proponent of routine rabies vaccination. I’ll even go so far as to raise the gruesome specter of the disease’s dreaded symptoms and universal fatality to get you to comply. I’m also not above using guilt along with scare tactics. Anything goes when it comes to mitigating the public health risk of rabies.
Why? Because I’ve had more than my share of close calls with this virus. And I don’t believe that declining a rabies vaccine every three years is in the best interest of the public at large, regardless of what you (or I, for that matter) may feel is best for your individual pet.
Sure, any vaccine carries risks. This one is no exception. The every-three-year protocols now widely available are built to minimize them. But there’s no denying that once in a blue moon (less frequently, actually) a pet will experience an adverse reaction to a rabies vax. No doubt about that.
Though they’re very rarely life-threatening, we know that every vaccine can theoretically lead to the kind of reaction evidenced by urticarial reactions (facial swelling or hives), fevers, respiratory distress, autoimmune diseases and even cancer.
This we know. And this we live with why? Because we’ve done the math and we know that the risk of widespread disease in the absence of vaccination is far worse than the individual risk of a reaction.
You don’t need to have lived through a parvo epidemic, a distemper outbreak or a colony-wide FIV infection to know this is true. You don’t even need to remember back to classmates with polio or the palpable fear of rabies back in the day to know that vaccines do their thing well. After all, it’s pretty obvious that smallpox and measles are nearly nonexistent entities as a result of modern medicine’s reliance on vaccination.
Yet ironically, it’s these very successes that are arguably to blame for the backlash against vaccination. They’ve made it much easier to for us to expect the kind of miracles even modern medicine can’t always provide (i.e., continued protection sans vaccination). Hence, the expectation that vaccination can be done away with once diseases are sufficiently under control...once the risk of vaccination starts to seem more harrowing than the disease itself.
Here’s where rabies serves as perfect example: Despite the undisputed excellence of our US rabies eradication program some seven thousand cases were reported last year. Of these, 300 of the rabies-infected were cats, which represents a 12% increase in feline cases––not an auspicious finding. And then there are the two dead humans to consider.
How many animals suffered vaccine reactions last year? Not sure. But the latest bit of independent research I have readily on hand is a feline study from 2002. It looked at 32,000 vaccine doses, for which 73 cats suffered localized tissue reactions (the most common kind of adverse vaccine event in cats). That’s a total of 11 cats in 10,000. And of these 32,000 cats, only 2 suffered potentially fatal sarcomas (the most feared feline vaccine reaction of them all).
It’s not a straightforward 1:1 kind of relationship to all rabies vaccinates and the risk of vaccination, but it gives you a rough idea. Is it worrisome? Yes. But it’s not a huge risk––not by a long shot. It’s what we call an “acceptable risk.”
Then there’s a new study to consider (sorry, not available online yet): For those of you who reckon your pets are safe after just one or two vaccines, think on this one:
In a retrospective study conducted between 1997 and 2001 (JAVMA Sept. 15, 2009), 41 states reported rabid cats and/or dogs. Of these, 21 submitted information on 264 rabid dogs and 840 rabid cats. Among the cases, 13 of dogs and 22 cats had been previously vaccinated at some point. 2 dogs and 3 cats were “current” on their vaccine and 1 dog and 5 cats had previously received two doses of the rabies vaccine. None had received more than two.
Scary, right? While vaccination is helpful, it’s not a surefire antidote to protection. That might give the anti-vaccination camp fodder, you might assume. Why assume the risk if one possible outcome is the lack of protection?
But you can see the other side, too? That’s the one that argues in favor of re-vaccination at regular intervals to secure the most effective immunity. Of course, it’s also true that pets who receive more than two rabies vaccines in their lifetime might also be those most unlikely to free-roam and interact with wildlife. An innate bias, indeed.
Either way you slice it, it’s clear that vaccination confers protections––albeit not perfectly. And we already knew that. Now the question is what percentage of the vaccinated pets in our midst are truly protected and how many are not. But unfortunately, that we cannot know. Not unless we challenge a sizable percentage of vaccinated pets with the virus. And we’re not about to do that. It’s neither safe nor humane.
Ultimately, it’s true. We do not have a crystal clear view of what the true risk of vaccination might be...not even if we measure all the reactions. Why? Because we can’t know whether protection is guaranteed in all cases.
Think about it: If protection is not necessarily conferred by rabies vaccine numbers 1, 2 or even 3 in some cases, the risk of reaction must take into consideration the additive, individual risk of all three vaccines. And there’s no good way to rub the Vaseline off the lens except through imperfect retrospective studies like this one.
Despite the additional murkiness studies like this inject into the already-muddied waters of the vaccinate-or-not debate, I can’t help but think there’s still no good reason to go without. I don’t care if your pet lives in a bubble, I’m still recommending vaccination––unless you can prove to me that he’s never had access to the outside world...unless you can convince me she never will.
‘Till then, I would hope you’d consider my position as a servant of public health. Because regardless of what might truly be what’s best best for your pet’s health (being the lone unvaccinate in a sea of vaccinates is undoubtedly ideal), I don’t believe the rest of the world deserves to suffer the heightened threat of rabies on the basis of our personal preferences.
Add Comment85 Comments
I live in rural Wyoming, and I don't require convincing - dogs, cats and horses are all vaccinated on the yearly or 3-yearly schedule as recommended. We have rabid animals in this and surrounding counties every single year. I can't believe the number of people here who don't vaccinate animals which live with their children, even though the clinics only cost $10 per animal! Several children have had close calls, including one small girl a few years ago whose border collie gave her life to save the child from a rabid lynx. Imagine if it had been the child's own dog or horse that had developed rabies.
Maria Shanley September 17th, 2009 01:19:27 PM
I have every intention of getting my dogs vaccinated regularly, but I am curious -- why is it that the immunity conferred is so short term? The only human vaccines I can think of that's given more than once in a lifetime are for the flu and tetanus. Obviously the flu virus changes from year to year, so that's a no-brainer. Tetanus is, I thought, every 10 years, or realistically, every time you injure yourself on something that might expose you to tetanus. But rabies and distemper? what makes them special?
Susan September 17th, 2009 01:33:58 PM
How do you feel about runnng antbody titers instead of yearly vaccines and only vaccinating as necessary when indicated by the titer levels? Is that a practical approach?
Sarah September 17th, 2009 01:58:05 PM
Susan: The immunity has been determined to last a certain amount of time based on manufacturers' tests of the vaccines' ability to allow the subjects to mount a strong immune response against the targeted invader. We have lots of in vitro (in-the-lab) ways to measure this but few in situ (in real life) methods beyond studies like this one.
The problem is that not all animals/humans will respond to a vaccine in the same way. So that even the tetnus vax can be said to "last" for ten years may not allow the human to mount an immune response at all. We don't measure our immunity against tetanus on a regular basis, after all, so how would we know? The manufacturers do try to keep abreast of this by testing the immune system of humans and animals that have received their vaccines. But, again, this kind of testing only takes us so far.
To delve a little deeper, I'll further explain it this way: A vaccine allows our bodies to respond to an organism by allowing our immune system to recognize it and have the ability to remember it the next time it comes in. Antibody levels are one way to measure that but cell-based memory of these organisms is also needed to repel it. This cell-mediated immunity is what we have a hard time measuring.
Dr. Patty Khuly September 17th, 2009 02:01:00 PM
Sarah: Your comment came in while I was posting Susan's response. Great timing. I just explained the difference between cell-based immunity and antibody immunity so that makes this explanation easier: Titers can only measure antibodies. That's why I don't rely on them anymore. Though they're still used in regulatory settings (such as when you want your dog to gain entry to Australia and need proof of rabies-free status), titers can only provide a limited amount of information.
I've written about this before and it's becoming clearer to me that titers are no longer too useful to determine immunity. I kinda think they're becoming overused in veterinary medicine as a way to give vets an easy way out from having to immunize your pet when you argue that you'd prefer not to (for reasons we all understand). But I'm starting to believe it's doing nothing but providing us a measure of false security I'd rather we not rely on.
Dr. Patty Khuly September 17th, 2009 02:06:33 PM
btw, I used to be a big proponent of titer testing before I learned to appreciate the shortcomings of this approach.
Dr. Patty Khuly September 17th, 2009 02:10:20 PM
Although my cats are indoor cats, I still make sure that they are vaccinated. What if they were to get out of the house and chase the wrong squirrel? Or run into the wrong stray cat? We have had two close calls with cats sneaking out the door and getting lost. Neko tore a hole in the screen door and was gone for almost 2 weeks! During a heat wave!. That was two horrible weeks of searching (we never gave up and spend hours searching the neighbourhood and constantly calling the shelter in case they found him). Knowing how easily my beloved pets can escape, its just not worth the risk to forgo the vaccine. Sure, our long haired Neko came back filthy, covered in burrs and fleas, dehydrated, ravinous and full of ear mites, but all of those problems were fixed with a bath and some relatively cheap medication. Rabies is a death sentence. One day I will have to say goodbye to my fluffy family members but to say goodbye over something that is preventable?!? I couldn't ever forgive myself.
Shauna September 17th, 2009 03:09:14 PM
"How many animals suffered vaccine reactions last year? Not sure." Now there's where my problem starts. You'll find it tough to persuade me when data is lacking. "But it's not a huge risk--not by a long shot. It's what we call an 'acceptable risk.'" How can it be an acceptable risk when the data is lacking? On what basis is it "acceptable"? That the rabies vaccine is generally at least largely protective? OK, I'll go with that. That it's sufficiently safe because the data on reactions is lacking? Nope, not acceptable in my book. I will continue to vaccinate my dogs but I won't vaccinate my indoor only cats because I've watched in the past as their health became worse and worse from each set of vaccines. Sadly, that also means I'm less inclined to even take them to a vet because I get tired of the battle; however, since they don't get vaccines, they don't get sick like they did when they were being vaccinated. (Does it all worry me? Hell, YES. On the other hand, I haven't had an escape for 11 years and that one didn't make it off the porch.) If there is ever decent post vaccine tracking of adverse events, I might be persuaded otherwise.
Susan, As humans are living longer and science is progressing, we discover new things. For example that Shingles is caused by the same virus as Chicken Pox. A modified version of the vaccine now used for children is also recommended for adults to boost their immunity as we now know that many vaccines only last a limited amount of time; they follow a modified bell curve which generally repeats if one is re-exposed. As we see less re-exposure because we reduce the incidence of disease and no longer live in extended, multi-generational families, we may well see more failing immunities with age. In addition, more and more people have compromised immune systems for a variety of reasons, including vaccines, and that results in failed immunities in some cases. Mononucleosis was believed by the medical community for eons to be a "once exposed, forever protected" disease. Turns out it can be caused by 2 viruses (EBV and CMV) and recurs sometimes from waining immunity, sometimes from failed immune reaction. I expect we'll be seeing more vaccines for adults in the future.
PJBoosinger September 17th, 2009 04:03:52 PM
<<I will continue to vaccinate my dogs but I won't vaccinate my indoor only cats because I've watched in the past as their health became worse and worse from each set of vaccines.>>
I totally agree with you PJB...I no longer vacinate my cats period across the board. Nor do they ever go out and no one has ever run out either. It's like they know that since all but one came from the streets, they never want to live that life again.
The dogs go out, occassional even socialize with others in our yards ( ie: wandering dogs) so they get the every 3 year vaccine protocol on all their vaccines.
These decisions I didn't make lightly, and did research the studies. It's the right choice for me and my pets.
On the human vaccine front..no me, no way. Not until all adjuncts are removed. I do not need metals in my body to stimulate my immune system so the manufactures get more for their buck. (wow, that sounds a little conspiracy theory but there it is)
LorriM September 17th, 2009 05:33:31 PM
If every pet person with an indoor pet was meticulously impeccable about their pets prescense at any given moment the need for rabbies vaccines "rule of law" style would not be as much an issue. Being impeccable and aware of ones surroundings and the activities occuring within it does not have to mean "uptight", but in this world of constant distraction, stress, the need to "perform" at work and be gone, transience . . what we are basically stuck with is a blanket fix one size fit's all with zero flexiblity. Quite frankly I resent it.
Like PJ mentioned I also get tired with the battle with the Vet over this. I never had an escape in 14, 16, and 18 years as well. What is it Vet's don't understand about this? Thats zero mistakes. Get it?
Okay I got that off my chest.
Evet September 17th, 2009 05:41:51 PM
This is a very interesting subject, and one that is close to my heart. I have the unfortunate distinction to have seen bad vaccine reactions both in my past work with animal shelters and with a dear friend's pup.
While neither were pretty by any stretch of the imagination, only one turned out to be fatal. Why? Because in each of the other instances someone was monitoring the animal after they received their vaccination. To me, this seems to be the key.
So few people realize that a vaccine reaction is possible. So, once they hear about it they tend to react badly and be afraid. What if, instead of sweeping it under the rug, we raised awareness of the possibility of a reaction and let people know that they should <b>watch their pets</b>? That way, if a reaction <i>does</i> occur, they can rush their beloved companion back to the vet for the necessary care.
On another note, Sept 28th is Rabies Awareness Day. Thank you for spreading the word about this truly scary disease!
Jane- Petfinder Blogger September 17th, 2009 05:56:10 PM
i've gotten into plenty "battles" with clients over rabies vaccines and their indoor-only cats. it never seems to be an issue with dogs, but with the canines at least i have the luxury of a safe 3 year vaccine that i can administer. since i use a non-adjavanted live canarypox vector rabies vaccine for cats ...it needs to be done annually (but it's still safer than using an adjuvanted vaccine according to the oncologists).
i encourage rabies vaccination for every healthy cat every year. i say "encourage" because NYS law requires it (and so do i) but i know i can't force a client to do anything. i can however refuse to treat an animal that is not rabies vaccinated. i need to protect myself and my staff against rabies exposure, so if there's a fractious cat who wants to eat us for lunch ...it's will get vaccinated for rabies whether or not it ever leaves the owner's 2nd story apartment.
i agree with dr. k that titers are not a reliable indicator of immunity to a disease. my reference lab would like me to think otherwise, but they stand to make a lot of money if i start doing titers. actually, i would make a lot more money too, because instead of running titers, i just skip to extended-interval vaccine protocols. it's safer for my patients and it just makes more sense.
how many adverse vaccine reactions have i seen in the past 5 years? maybe 6? no cats. and the dogs all reacted to one batch of rabies vaccine that we deemed was "bad." since switching manufacturers of rabies vaccine (we use merial imrab 3 for dogs now) i have not seen any reactions. at least of the short term variety. and no cat reactions. zip. zilch.
Dennis Leon, DVM September 17th, 2009 07:43:21 PM
"On the human vaccine front..no me, no way." I'm right there with you. I have a dysfunctional immune system and, despite the "don't give this to..." warnings, every year some doctor tries to talk me into a flu shot. Live virus VZV vaccine? Nope, not a chance! But, these days, I try to stay up on human, cat, and dog vaccines just so I know what someone going to shove at me on the next trip in :)
PJBoosinger September 17th, 2009 07:46:51 PM
Regarding indoor cats, maybe you can be 99.9% certain that they won't get out. How can you be completely certain that wildlife (which may be rabid) can never get in? I am thinking in particular about bats, and also the admittedly rare cases around the country of a rabid fox or raccoon crashing right through a screen door.
Maria Shanley September 17th, 2009 08:10:16 PM
"i can however refuse to treat an animal that is not rabies vaccinated." Agreed. However, do you understand that YOUR office (meaning, a vet's office) is THE most dangerous place my cats will ever have to be? I really think there should be some way I can get my cats (and dogs) seen and treated in a reasonably safe place, not one where there are multitudes of biological hazards. Home visits are a step up but then I have to worry about what the vet has brought into my home :)
"if there's a fractious cat who wants to eat us for lunch ...it's will get vaccinated for rabies whether or not it ever leaves the owner's 2nd story apartment" Did you mean to imply that you'd vaccinate a cat without owner consent, perhaps merely because the cat's having a bad day and might be less "fractious" on another day? Yes, we know the states require the vaccine. We also suspect vets'll rat us out to the authorities if they even know the cats exist, let alone if we battle with you about the vaccines. (Even vets have fractious days :)
I agree that antibody titers alone won't cut it but they help in humans when combined with an overall analysis of immunity with panels that include these and some other items (sorry, don't have my own medical records and research unpacked so working from poor internet sources). I haven't gotten around to asking vets is such testing is even available for pets.
PJBoosinger September 17th, 2009 08:12:28 PM
Maria, In my house, they're going to have to run the gauntlet through a Shiba Inu (with very high prey drive), a Lab (who's going to follow the Shiba's lead if not act on her own initiative concerning an "invader"), and a Lab Mix (that mix probably includes Doberman) and that's AFTER they've run the neighborhood gauntlet of male dogs who run loose. I'm thinking there's way less than a 0.1 percent chance (rabies being pretty rare these days and the "through the screen door" even more so) and, well, life comes with risks and all we can do is balance them. Seems more likely I'll get hit by a bus and die, leaving them "mommy"-less and I take that risk every time I go shopping.
PJBoosinger September 17th, 2009 08:21:16 PM
You don't have to convice me. We require rabies vaccinations on every animal that passes through our grooming doors. If we can't verify it we send them away until we can. We lose clients this way, but I've seen a 4 year old boy getting the rabies shots at the local hospital and it's not pretty. Even now with all the advances in medicine. I have an indoor cat that I adopted and I get him vaccinated as well. What if he bites someone that visits my house, forget about him getting out. I don't want to get sued from something happening in my own house. It's always a possibility, all animals with teeth may bite, why chance it?
Sharon September 17th, 2009 08:25:37 PM
@PJB: i don't rat anyone out for not having a rabies vaccine. it's not worth my time. ALL bites however do get reported to the DOH. and if the pet is not up to date on a rabies vaccine, it's subject to a quarantine -sometimes 60 days. and sometimes they will require the quarantine be done at a veterinary facility at the owner's expense. i don't do anything without the owner's consent unless it's a lifesaving measure. but a "cat having a bad day" can end my career with one well-placed bite. so if i'm going to be unemployed, i'd rather not have rabies at the same time ;) i'm not aware of any widely available immunity testing besides basic titers. i will bet though that my dog is immune to parvo and distemper for the rest of his life, lepto for only about 6-8 months at a time, and rabies for ...who knows?
@maria: you're absolutely right about wildlife getting in. when i lived in san francisco, i once found racoon prints on my bed! they had stolen my cat's food. luckily we were upstairs watching tv (likely some really bad reality show). this was a densely populated residential area in the city of SF. and i had 'coons on my bed. not cool. it made me glad that my cat and i were both rabies vaccinated.
Dennis Leon, DVM September 17th, 2009 08:31:50 PM
these back and forth arguements are all fine and good and intrenched in what ifs...and like all vaccines, even the rabies is not 100%.
In 30 years of living on my own, I have never had anything more then a field mouse get in my house that wasn't a bug. But it's nice to see that the die hards are taking the scare them approach rather than accepting that some people have good reasons for their decisions.
Dennis, sorry but with your comments, I'd never let you near my cats. Good thing we live on opposite sides of the country.
LorriM September 17th, 2009 08:42:58 PM
"What if he bites someone that visits my house" 1) It's my house; 2) I inform guests and they can either accept the risk, not come in, or I can confine animals (which, since I have a zoo, is the norm most of the time when I have visitors).
OK Dr. Leon, so you only report in "certain" cases, like a bite, because the law requires it. Don't get me wrong, I totally understand. Yet, the law could require you to report any animal that you've seen that you believe hasn't been vaccinated and it could be retroactive reporting and it sounds like you'd comply SO again there's a fear factor. I also understand your fear of injury but, to me, that's all the more reason for me to restrain my pets. I'm willing to take the risk with MY cats and I'm willing to endure the series of shots should I deem it appropriate and all without the involvement of some health department and their "one size fits all" punitive set of SOPs. (In addition, I have no problem with muzzling any of my dogs or cats prior to them being around vets and staff. In fact, I prefer it. With the cats, there's not much reason for a vet to be in their mouths unless something needs done in there and then you'll have to knock them out so I'd rather knock them out. Yes, I know it limits the exam but that's just one of those compromises I can live with.)
I'd be leaning in LorriM's direction just now but I see Dr. Leon is a mere 4 years in his own practice with a few weeks of blogging under his belt. I'll give him some time to find his "voice" and "tone" since I know that can be difficult and frustrating :)
PJBoosinger September 17th, 2009 09:32:28 PM
What did Dennis say that was so bad? That he would report a bite? That's required by law!
I work at a vet clinic, and a cat bit me last week. We have no vaccination history on that cat (first visit to the clinic, owner has no records, nor does he know the last vet seen). That cat is on home quaratine to watch for rabies. And I'm on antibiotics for the infection it gave me. Rabies would just be icing on the cake.
JM September 17th, 2009 09:48:51 PM
JM: surely you are or have received rabies vaccines, if you got bitten by an unknown. If you are waiting to "get rabies", you are waiting a bit too long!
About titers: they are acceptable standard of care in humans, why wouldn't they be in animals. I was tested for rubella years ago via titer and found not to need the vaccine---it was great!
Now back to the rabies, what study found rabies in an absolutely confirmed case of two vaccines given: one in puppyhood and subsequent year later? I'd like to read that.
And since distemper/parvo doesn't create the hysteria of repeated boosters, I can't help but wonder why it would be thought that the rabies would be any different.
Regardless, all vaccine inserts state : only for use in healthy animals
PJB: I'm with you, particularly with elderly animals. Why compromise their immune systems any further. BTW, my own human "physician" did NOT recommend getting the flu vaccine last year. And she had NO way of knowing my opinions on vaccines (unless a reader here!
It is always easy to cite statistics---until you become one!
Barbara A./NH September 17th, 2009 11:34:38 PM
There was a case in Iowa of a caat who had NOT been out of th ehouse in 6 years that contracted Rabies. It isnt worth the risk given the certain fatality if a human is exposed and the cost ($6000 for one of my clients a few years ago..) for post exposure prophylaxis. I have gone to requiring that rabies vaccine be administered if I am to be the veterinarian. It may not (and likely will not) be given on an initial visit if there is fever, illness, stress or other vaccinations, but if I am to be the caregiver, the patient will have rabies vaccine. Kim
Kim Houlding DVM September 18th, 2009 02:32:55 AM
Barbara, You give the perfect example. I was titer tested for rubella when I was pregnant and it showed I didn't have immunity (my mother was sure I'd had rubella in infancy and we could document my immunizations too) so I was vaccinated post-partum on my doctors insistence. I spent 2 days feeling like I had been on a wrack, being pulled apart at the joints. So much for that "mild discomfort from vaccines" that the doctors warn mothers their children may experience. I had no doubt of the pain my child was in after being vaccinated and I suspect the same with animal vaccines. Oh, and I was tested a few months and a year after the new vaccination. Immunity? Zero, zip, nada - so said the titer test. On the other hand, my EBV tests say I'm well protected from it. Well protected until the test that shows I have the one antigen that means I'm actually GETTING a case of Mono. EBV testing is by antigen rather than antibodies but, for us lay people, it's all part of the puzzle we need to learn. In recent years, they've really started learning a lot more about the immune system and one of the biggies is this: "allows a single antibody to be used by several different parts of the immune system" and other parts of the immune system can step in if the antibody isn't there or doesn't develop. So a test titrating "an" antibody may not show immunity to the disease being tested for and some may be immune without the antibody at all. Humoral and cellular... OK, going to stop since my head is already spinning. Titers are still the standard of care in human medicine - they should NOT be these days, at least not standing alone.
But one of my general objections to vaccines is that we have been and keep giving them despite not really understanding very much of this "immune system" business, as evidenced by the daily discoveries in this area of science. We're just too willing to provoke the immune system and ignore the short, let alone long, term consequences. In fairness, I have to say that my cats were fully vaccinated for the first 3 years of their lives before I stopped vaccinating them. I don't know what I'd do if I got a new kitten!
JM, I think we were talking about his postings collectively rather than just one entry, at least I was. For me, it's overall tone more than anything else and I suspect at least part of that is that he's posting rapidly. I often tend to do the same so my tone is more off or harsh than intended. "That's required by law!" And why are veterinarians allowing the government to turn them into their agents? Aren't vets grown up enough to decide whether or how much of a risk it is and have a discussion with the client to resolve it rather than having the government step in for them?
PJBoosinger September 18th, 2009 02:50:08 AM
Kim, "given the certain fatality if a human is exposed" And every bit of your credibility as a "professional" just went out the window in my book. Either it's "certain fatality" or there's "post exposure prophylaxis". You can't really have it both ways, especially since it isn't the least bit certain to be fatal and, if it were, why would there be any post exposure prophylaxis?
"if I am to be the caregiver..." Got it, you make decisions, client input not wanted. Thanks for the warning :)
PJBoosinger September 18th, 2009 03:03:59 AM
It's interesting to see how this "battle" always shakes out. It's not surprising that pet professionals are almost invariably on the side requiring vaccination while a few legitimately careful/fearful/skeptical/independently-minded pet safety advocates cry foul.
A few points:
1. Those who don't work in a setting where "a cat having a bad day" can mean a round of very expensive/uncomfortable post-exposure vaccines perhaps can't thoroughly appreciate the stress we deal with on this subject when it comes to our personal safety and that of our staff (not to mention the legal liability should anyone present, including the owner, suffer a bite). There's nothing worse than having to tell an owner that the public health department is demanding their animal be quarantined or worse...
2. We do have stats on how many vaccine reactions are reported. The FDA requires that we compile these. Are they always reported? No, they're not. That's the problem. The same, however, is true in human medicine. Reporting will always be a problem. However we do have ways of compensating for this statistically so that we can still get a very good sense of whether vaccines are causing problems.
3. Anecdotally speaking, I have seen exactly one deadly vaccine reaction in 25 years in this industry. And that was in vet school where we see the worst of the worst. I have seen about 4-5 vaccine-associated sarcomas (none in the past 5 years since the vaccines' adjuvants were changed and never from a rabies vaccine).
4. If the severe vaccine reaction rates were higher, welfare-minded veterinarians like me would be clamoring for reform. Nonetheless, we are always moving towards more judicious about our vaccine protocols because we *know* that more vaccines offer more opportunities for reactions. In other words, the industry is responding despite the low reaction rates. Example: When vaccine-associated sarcomas proved a big problem, we worked hard to fix it. Those rates have been significantly reduced thanks to the VAS Task Force.
5-We cannot take an owners' word that their animal remains indoors at all times. YOU may be sure, but WE can't make serious public health decisions based on your say-so. Not when it comes to something as uniformly fatal as rabies.
6-Sorry to say but scare tactics DO work when nothing else does. There's nothing that gets pets more rabies vaccines than news of a rabies-infected cat in your area. If we knew the true prevalence of rabies (likely far higher than the tip of the iceberg numbers I cited in the post) we'd all probably sit up and take more notice of a disease that still threatens us mightily.
Dr. Patty Khuly September 18th, 2009 07:28:35 AM
Sharon, what where you thinking "wasn't pretty"(you said you'd "seen a 4 year old boy getting the rabies shots at the local hospital and it's not pretty"), exactly? I'm just wondering because so many people try to pull out this image of 14 shots with a giant needle, right into the stomach - when that hasn't been how it's done in at least 25 years!!!!
People, it's 3 shots in the arm - and they don't hurt the average person more than a tetanus vac (which can cause soreness, but it's not as if you want to chop your arm off from the pain, for cryin' out loud). And speaking of tetanus - lockjaw is also considered a terrible, horrendous affliction to be avoided at all costs, by vaccination. Yet, there was a period of time (approx. 18 months) when getting a yetanus shot was difficult because of problems with the manufacturer. If you got an injury that would normally require a tetanus booster doctors cleaned extra carefully and insisted on antibiotics because they didn't have vaccine to use. There were two instances during the mid to late 90s, when I gashed my hand on a rusty fence/metal tool, and both times I was told, "sorry, no vaccination available, make sure you take these." Since tetanus is a bacteria, I could see the logic of the pills, but the lack of vaccine (since I hadn't had a shot since I was 15 - 20+ years previous) was disconcerting.
Also, where in the world does anyone live (Kim Houlding) that post exposure rabies vaccinations cost $6000? I've had them, and admittedly, it was 9 years ago, but it was about $900 for all 3. I do think rabies (and distemper/parvo) vaccinations are important, my dogs were vaccinated (multiple times i.e. several more than 2), but after they turned 7-9 years old, no, they aren't getting them anymore unless I am forced. If they haven't developed immunity by now, they aren't going to. And having had a beloved cat die from a vaccine-related fibrosarcoma (that I had 'removed' twice), I'd be extremely careful, when I get another cat, about doing more than absolutely necessary too.
Oh, and for everyone patting themselves on the back about not having cats escape - don't think it's your vigilance. House fires, break-ins, gas explosions/evacuations, etc. are possibilities that you never think will happen, but during which, your hypervigilance about doors and windows isn't going to count for as much as you think.
KateH September 18th, 2009 08:54:44 AM
Isn't it true that there has been not one single human death from rabies in the US in over 30 years when timely post exposure prophylaxis has been given? That the majority of human cases of rabies are brought in from abroad? Let's be clear when we are saying how deadly rabies is that we're talking about the risk of fatality to the animal; not to humans. And, in fact, that risk is somewhere around 0.00001% for animals?
If what you're saying in #1 is that you're so stressed by government pressure that it affects your objectivity, that's not a scientific basis for making a medical decision on the validity of vaccinating my animals; if you're saying your own fear interferes with your objectivity, ditto. And, oh, yes, there is something worse than having to tell an owner their pet is being euthanized and that's having your pet euthanized! I will give you your stress and fear when you acknowledge ours are valid and there needs to be balancing of these rather than "we're the pros, we get to decide".
While I understand the point you make in #5, that is the attitude that sets up the distrust. It's why we don't bring them in at all except for emergencies and we go to the gray market for meds. It's why we trust vets less. (Yes, I'm sure they teach the "all clients lie" rule in the first year of vet school just like they teach the "all patients lie" rule in the first year of medical school. Now just think about that. Doesn't tha just set up a wonderful beginning for a relationship that needs to be based in trust on both sides?)
You are absolutely correct that scare tactics work. At least they work until people get facts and then those scare tactics come out as lies, years and years of lies from people we trusted. And we feel betrayed.
I know all about "anecdotal". That's where it's real if the member of the medical community observed or felt it and not if someone else (like a patient, like a pet who might actually feel pain after all) did. Well, that's until a medical professional professes something the broader medical community declares implausible and then he/she better shut up or else becomes one of "them".
So I'll ask you a question you asked a while back: Does a vet do what's in the pet's best interest (even if that is leaving them with no health care at all because the owner declines vaccines) or do you do what's in the best interests of the greater good, the public (based on your own refusal to believe the owner)? And my own question, is it even either of those or "us v. them", vets first and foremost, pet health second (at best)? (I don't actually have a problem if the answer to that last one is "vets, first, last, and always" and I'm not being contrary as some have become fond of accusing me of being. That would probably be the honest answer and I'd rather see that than bootstraping a personal opinion into a professional one or inflammatory scare tactics that will result in later backlash.)
I'm also sure you know better than I that there are vets who disagree with you. I've come to know one on one of my email groups recently. So, please don't make this a "we professionals" v. you, the rest of you when people make rational arguments that oppose/dispute your professional opinion.
PJBoosinger http://pjboosinger.viviti.com/ September 18th, 2009 09:05:29 AM
KateH, the CDC recommends 5 shots, don't know if they've adopted the proposal to reduce it to 3 and there's evidence that 1-2 actually gets the job done. Of course, anyone who's been pre-vaccinated (vets?) only needs 2 relatively simple IM shots, you know the same kind as the vaccine for the animals so nothing to fear at all. Right?
And why isn't there a post exposure prophylaxis for dogs and cats?
PJBoosinger September 18th, 2009 09:41:08 AM
That should have said "proposal to reduce it to 4". Sorry.
PJBoosinger September 18th, 2009 09:56:18 AM
For those who enjoy looking at numbers and statistics, here's a summary:
55,000 humans die from rabies every year
a person dies from rabies every 10 minutes (worldwide)
7,259 total rabies cases reported in the US in 2007, including 274 cats, 93 dogs, and 1 human
100% fatality rate of rabies after clinical signs appear
6 months quarantine for an unvaccinated cat or dog if bitten by an animal suspected of having rabies (assuming cat is not euthanized)
@LorriM: ouch. what exactly did i say to deserve that? so i'm an evil veterinarian for caring about public health and the safety of my staff, patients and clients? or is it because i report bites to the DOH? or maybe that i skip unreliable expensive titer testing and just do extended vaccine intervals? perhaps my choice of non-adjuvanted vaccines for cats? or my other steps to reduce my vaccine reaction rate to nearly zero? do you feel the same about dr. k? -after all, she's defending rabies vaccinations as much as i am. either way, i'll need to revise my article on how to choose a veterinarian to include "review their blog postings."
@PJB: not sure if you were backing me up or putting me down, but if you're gonna list my credentials here, at least give the complete story. and although my own blog has been up for a mere 3 weeks, i've been writing for decades. what you see is what you get. thanks, but my tone and voice are set. i'm no more (or less) rough around the edges in person vs online, although it can be tough to read through my sarcasm and dry humor. as for veterinarians being an agent of uncle sam ...we kinda are. our veterinary licenses are granted to us by the State. and as a USDA accredited veterinarian i am indeed a representative of the federal government. any scare tactics i use in practice are grounded in facts, not opinion. i never have and never will lie to my clients. lastly, if you're better at restraining fractious cats than my staff, then i will hire you now -just name your price!
Dennis Leon, DVM September 18th, 2009 10:16:17 AM
$6,000 might be right: "direct medical costs associated with postexposure prophylaxis included
and I have no doubt at all that the US price is the upper end of those. There's only 2 manufacturers for those drugs. How can there possibly be that kind of price range? We SO need to fix the human health care system; starting with these drug company rip offs!
PJBoosinger September 18th, 2009 10:17:37 AM
PJ, I was working with bats, and 3 shots were the protocol. I've spoken with others who've gotten them in the past 10 years, and they also only got 3.
And that's an interseting question about post exposure shots for pets. At two clinics I worked at, in the past 15 years, there were dogs (1 at each place) that tangled with raccoons. Both dogs, even though current (within the past year, as was SOP up until 2-3 years ago in NEOhio) on rabies vaccinations, were given another vaccination during the prep for surgery. They had to stay in quarantine ( both dogs only 10 days) to see if rabies developed (and that's another can of worms I'm not getting into, since I've read it can take longer for symptoms to develop), and both were deemed safe to be 'released into the general population.'
So, were both those vets wrong - even though they followed county health department protocols?
Oh, and Shauna, please don't worry so much about squirrels. "Rabies and Squirrels: An Overview Squirrels are almost never found to be infected with the rabies virus. Squirrels also have not been known to cause rabies in humans within the United States. Bites from a squirrel are not considered a risk for rabies unless the animal was sick or behaving in an unusual manner, and rabies is widespread in the area. In all cases regarding rabies and squirrels, consult the state or local health department before making a decision to begin rabies treatment. What About Rabies in Other Rodents?Besides squirrels, other small rodents (such as rats, mice, hamsters, guinea pigs, gerbils, and chipmunks,) and lagomorphs (such as rabbits and hares) are almost never found to be infected with rabies and have also not been known to cause rabies among humans in the United States. However, from 1985 through 1994, woodchucks accounted for 86 percent of the 368 cases of rabies among rodents reported to the Centers for Disease Control and Prevention (CDC). Woodchucks or groundhogs (Marmota monax) are frequently the only rodents that may be submitted to state health departments because of a suspicion of rabies." (From: rabie.emedtv.com) I've worked with wildlife rehabbers and biologists and none of them had ever encountered or knew of a case of rabies in rodents (or lagomorphs/cavies) smaller than a woodchuck. The reason is that if a rabid animal were to bite a smaller rodent, that animal is most likely going to be killed or maimed so badly in the encounter, that living to transmit rabies to anything/anyone else is statistically improbable. Woodchucks, however, can be tough critters to kill, and if they get into their burrows after getting bit, that's when the disease survives.
Lastly, interesting fact about opossums, is that, except when the virus is injected directly into their brains (as has been done in laboratory research), their low body temperature seems to prevent them from developing rabies. I've been bitten several times by opossums and, oddly enugh, even with barely cleaning the wounds on two occasions, they never got infected, either.
KateH September 18th, 2009 10:24:30 AM
Dr. Leon, please don't omit (whether consciously or not) that 99% of the human rabies cases happen in Asia (especially in India) and Africa, with some in South America. As you noted, in 2007, there was 1 human case in the US.
Oh, and PJ (et al.), I misspoke. My 3 shot protocol was for PRE-exposure. And I still contend that any place that charged $6000, even for post-exposure shots, is, as mentioned, gouging whoever it is that ends up paying.
KateH September 18th, 2009 10:35:51 AM
"not sure if you were backing me up or putting me down" actually just trying to be lenient but I'll stop :) And I'll stop there since I'm sure I'm now on Dr' K's "to be slapped" list.
As for being a gov't agent, yeah, we know and at least you're honest about it; doesn't mean I have to like it or approve of just letting the state or feds run the show without a fight. On average, a patient doesn't even know what the fight is unless a doctor informs them so it behooves doctors to fight on behalf of their collective patients, IMO.
I'm better at restraining MY fractious cats than your staff, that I can guarantee; I may indeed be better at it generally than your staff if they do it as poorly as the average vet staff member I've seen in action with a cat.
"review their blog postings." Yep, and hunt down every detail about them I can find! (Dr. K has a lovely homestead and I haven't been in Florida for over a decade. It's amazing what you can find on-line these days. Admittedly, I'm cheap so what I get is dated because it's free and I don't spend much time on it but I looked up the aerials back when I was house hunting.)
PJBoosinger September 18th, 2009 10:37:32 AM
at the risk of also being put on dr k's to be slapped list, i'll say one last thing to pjb:
i'm a big boy. no need to hold back. and no, they did not teach me "all clients lie" at vet school. but they did teach me "the internet provides just enough information to make a client a pain in the butt." although i'd probably actually like you in real life ;)
done. will write my own blog today about the dangers of going to vaccine clinics.
Dennis Leon, DVM September 18th, 2009 10:49:42 AM
PJ, I agree with you about the average vet staff not handling animals well - and I've BEEN vet staff! Handling techniques are dictated by the vets, and a majority of vets I've met and/or worked for, prefer techniques that run from 'not good' to 'downright abusive' to the animal. And trying to get the vets to even consider changing anything is a funny ha ha. Many times I suggested or just tried something different, that would be less rough, I was either laughed at, or told "NO."
KateH September 18th, 2009 10:51:06 AM
Dr. L, Fair warning, I remember things like that :) Hey, I like just about anybody who doesn't huff away from a good debate! If you think the internet makes us pains, you should know I used to spend my free time at the Medical School library - self defense from my own doctors!
KateH, I took in a stray dog, took her to the vet and got her vaccinated. About 8 days later, she bit my Shiba who was 1 month past time to get her 3 year vaccination for rabies. My initial reaction was to have a heart attack (that's the influence of all those scare tactics at work). Vet gave my Shiba a rabies vaccine, told me not to worry about that part (didn't recommend isolation or quarantine of either dog). I can remember the farm dogs ONLY getting a rabies vaccine after they'd been bitten by something wild. They might have been isolated for a time but I don't remember that.
My Shiba and Lab have been absolutely current since birth until this year (they'll be 9 next month) and I was a month late getting them in. Of course, that means going to absolute WAR with a vet over the next 2 years because I'm not doing the 1/year for 3 year series, period; not doing it! Due to a prior vet, they've already been over vaccinated for rabies! I may never get this vaccine for them again given their ages.
About the only thing I'm sure of with rabies vaccine is that the human version is most assuredly more safe than the ones vets want me to give my animals because human drugs go through more testing. So, if vets fear ever having to have a few doses of it, then I'm darned sure afraid to give the animal one to my pets.
PJBoosinger September 18th, 2009 11:06:09 AM
@KateH: I am admittedly not a good restrainer. I leave that to the pros. All animal restraint is done here by my technician and assistants. Handling techniques here are dictated by my nursing supervisor. Rule #1: "don't let the doctor get bit." As long as they're not abusing, hurting or otherwise harming the pet, it's ok by me. I've seen some pretty horrible examples of animal restraint at other hospitals and been at the biting end of improper restraint by less-than-qualified holders.
Dennis Leon, DVM September 18th, 2009 11:27:53 AM
"since i use a non-adjavanted live canarypox vector rabies vaccine for cats ...it needs to be done annually (but it's still safer than using an adjuvanted vaccine according to the oncologists)." -Dennis Leon, DVM
My biggest fear is still fibrosarcoma. 26 staples in a cat is a horrible sight and that was only one of his 6 surgeries. Not to mention radiation. He was a trooper and did not let cancer win (renal failure later won instead). My current vet uses the newer annual rabies vaccines mentioned above, but I still worry more about fibrosarcoma than rabies. Are these really safer than the old kind and are annual vaccines really necessary? I keep seeing that with more testing that they may extend it to three years, but I worry that vaccinating too often leads to cancer.
Marlys September 18th, 2009 11:40:22 AM
@Dr. Leon, a training school near me would like to bring Sophia Yin in to do a seminar for vets/staff on handling techniques and 3 out of 3 (yes, miniscule n, but 100% as expected and 90% extrapolatable, IMO) vets said, "No interest, wouldn't help staff with costs"). As many of us on here, whether ever being vet staff or not would probably say, animal restraint at clinics varies widely in competence, as well as compassion. If vets took the time to learn to do it well, then they could train their staff better. Just because you have others do it for you, doesn't mean it's being done well. I know that many clients can't do even half as well as the average vet staff, but when a client, like PJ, or me, says they can do it better, it would be sensible to find out why they feel that way. Perhaps they've seen horrendous examples, and you should know if it was elsewhere or at your place, so you could retrain if necessary. I admit to always feeling a bit ... miffed, when a client said they would hold their animal, but if they'd explained why to the vet, and showed the vet they could do it, well, they were right - they did know what they were talking about.
KateH September 18th, 2009 11:56:54 AM
@Marlys: i haven't seen a vaccine related sarcoma since graduating from cornell in 2001. it's probably just a matter of time until i do. the risk is low (1 in every 10-20,000 cats depending on which source you believe), but the risk is cut by 80% by using non-adjuvanted vaccines. when merial gets a 3 year label on their purevax rabies, i'll be right on board with moving to a 3 year protocol. many veterinarians would unfortunately be too afraid to lose the $30-50/cat/year in vaccine income ...and they should all be stripped of their licenses! let us not forget that the new terminology replacing "vaccine related sarcoma" is now "injection site sarcoma" which means ANY injection can lead to the series of unfortunate immunological events in a cat that results in a sarcoma (even sterile water according to one source). but that's at least one of the reasons why i also stopped using injectable Program in cats, rarely use Depo Medrol, and will not be stocking Convenia (at least for cats) anytime soon.
@KateH: i'm fortunate enough to have a technician is is able/willing to train the rest of the staff on proper restaint. she has also taught numerous volunteers, interns, doctors, and dog trainers. believe me, it's being done well, and it's being done humanely here. i was a better restrainer when it was my job to restrain and protect the doctor, but the days where i need to take a bite are long gone. there is a liability issue when owners restrain their own pets. what happens if they get bit? i'm at fault for allowing them to restrain. but if you can do it as well or better than my staff AND you pinky-swear that you won't sue me if you get mauled by your cat ...then by all means, you can hold while we do an exam or get a blood sample.
Dennis Leon, DVM September 18th, 2009 12:31:52 PM
"there is a liability issue when owners restrain their own pets. what happens if they get bit? i'm at fault" No matter how often you vets repeat that, it won't make it true. That is such a load of B.S. AVMA needs to hire a decent lawyer to draft forms for you guys to use.
PJBoosinger September 18th, 2009 01:09:35 PM
Oh, and to the extent there is POTENTIAL liability, that cuts both ways which is exactly why I don't want YOU holding my critters - so I don't get sued when you claim I "knew" my animal was ferocious and inclined to bite and didn't warn you appropriately. I'll take the possibility of the bite over an award for your lost wages, thank you very much.
PJBoosinger September 18th, 2009 01:12:40 PM
Backing up. There were 2 human deaths in the US last year that I can find and both were from bat to human bites: A Missouri man who didn't seek any treatment and an illegal immigrant who went to the hospital and lied (and apparently the M.D.'s didn't recognize the "froth" factor as significant :).
And moving forward, well, actually going back a year or so... Oh, I so love this part. There's a cheaper, better post exposure prophylaxis available. And you just have to love that the American vaccine I cited above at a minimum of over $100/shot, is REAL cost of $39.60 for 5 shots. And it's designed to be administered by lay people so is intradermal. I presume a vet would be comfortable self administering that? Yes, Dr. L, I found that on the internet and that may make me a pain in the butt but it doesn't make me wrong :)
PJBoosinger September 18th, 2009 01:45:12 PM
Perhaps the following was discussed an earlier post, but it deserves mention here:
Dr. Ronald Schultz, of the University of Wisconsin veterinary school and the nation's leading expert on veterinary vaccines, is in the midst of conducting five and seven year challenge studies on the rabies vaccine. The project's aim is to change legislation mandating too frequent inoculation with a vaccine believed to be associated with numerous side effects. The research is being funded by a grass roots organization with tax exempt status: The Rabies Challenge Fund, for which Dr. Schultz and W. Jean Dodds, DVM serve as co-trustees. In today's economy, the fund desperately needs your financial support: http://www.rabieschallengefund.org/ .
Lisa in Cape May County, NJ September 18th, 2009 01:45:25 PM
pjb, you can argue that all day long with my insurance company. there's a reason why they (the insurance folks) distribute pre-made signs to us that say things like "keep your dog on leash" or "please allow our staff to restrain your pet." i personally never have and never will sue a client for "allowing" me to get bit by their secretly ferocious dog/cat. getting bit (scratched, peed on, etc) is an accepted risk of my profession. and i am covered by my hospital's insurance policy as well as worker's comp. it is NOT an accepted risk of being a client at a veterinary hospital, nor do i want it to be. i would actually much rather have my staff get bit than my clients. you seem to think otherwise... as a lawyer, you should know that anyone can sue anyone for anything -who wins in court is a totally separate issue. i just don't see much of a case for a veterinary team who allows an untrained owner to restrain an aggressive animal. "but he really Really REALLY wanted to hold" doesn't sound like much of a defense to me. but i'm not a attorney. of course this would maybe be less of an issue if there weren't so many personal injury lawyers advertising their services on tv, radio, and billboards...
Dennis Leon, DVM September 18th, 2009 02:05:27 PM
"it is NOT an accepted risk of being a client" but it is a risk of being an owner, especially one who wants to handle and an owner certainly has the right to waive their own potential risks, could even indemnify. "can sue anyone for anything" Yep, so today you say you have no intention and tomorrow... Your clients are to take your representation at face value but not you, theirs. There's that one sided trust thing again. It's somehow OK for you to set the rules because you're the vet but me, well, mere owner me, who also has potential liability, dismissed out of hand as "untrained" because I'm not a vet or trained by one. Can you see the arrogance built into those presumptions and conclusions you're making? It's certainly not your clients' fault you're letting the state, feds, now your insurance run your life, your business but it is they or their pets who might pay the price for that arrogance. Yes, there are reasons why the insurance company requires you to... but they probably aren't the ones you thing. And, if you think it's that easy to find an attorney to sue, even for "personal injury", more especially on contingency, you've probably never tried to hire one.
After the way my most recent newbie vet botched the job, letting my Shiba wake up unattended, rip out her new drain, caused a second (worse) hematoma, fluid in her chest (both from manhandling, I'm sure), AND a resistant hospital acquired infection for which she failed to prescribe and dispense an appropriate drug (resulting in at least an additional week [during which she saw my Shiba twice and darned well should have recognized the worsening of infection] of misery for her and exahuastion for me); not to mention having to be anesthetized a second time... All from what should have been a very simple procedure (I have, in fact, treated worse injuries at home like when my Lab was injured years ago while at a vet being boarded and ripped off part of her neck on their kennel fencing so, of course, was terrified to go to a vet for treatment, especially since they let it fester for 2 days instead of calling me and during which the vet, yes, the VET hosed her back from the gate so they could put food in the kennel, again instead of calling me, this was their decision) and, even that was probably unncessary. Well, you'll just have to forgive me for thinking maybe it would have gone better if she'd woken up in MY care; if I'd been the one handling her all along! And, if she did bite someone after waking up alone, freaked out and paniced; at least they had the good sense not to mention it to me.
And all of this is OT and a red herring because it doesn't change that rabies threat to and from pets is being grossly exagerated as a hazard with the same "one size fits all" perspective that governments impose while the newest, simple, easy, cheap post treatment for humans is being utterly ignored. All that just so vets can continue with an arrogant insistance on an outdated protocol! Now, THAT'S the nonsense that will be the stuff of future lawsuits!
PJBoosinger September 18th, 2009 03:21:39 PM
Wow, I had no idea that rabies still was so prevalent in the pet community. When I think of rabies, I think of bats and raccoons---not cats and dogs. This is a very informative article, and I hope it's made a few more people give a good long look to the importance of this vaccine.
www.mad-about-pets.com
Celia September 18th, 2009 04:43:12 PM
PJB: hmmm, you are sounding more like Stefani and I. First of all, I want to see any published findings of a human rabies case from a dog or cat verified to have 2 vaccines (one beyond a year of age). Second, many states have now recognized the adverse reaction & potential for making a compromised animal "sicker" upon vaccination. Otherwise there wouldn't be any rabies "waiver" additions to the laws.
Just imagine that my state of New Hampshire, out of great concern for dogs, passed this revision a year ago! And this comes from support of the veterinarian community! Now, imagine once again, that it is nearly impossible to obtain this waiver.
And all this in a state that has NO interest in clarifying its HUMANE euthanasia law, Apparently the veterinarian community sees no importance in stating in writing what is humane and what is not ! I find it ironic and extremely sad---
Does any of the states require oversight on cat rabies compliance? What about all the barn cats & ferals?
Barbara A. Albright/NH September 18th, 2009 05:20:45 PM
Lisa, Thanks for the link. I've already emailed them for info so I can try to russell up donations.
"you are sounding more like" Yeah, I should say thank you to the vets. Setting off my B.S. meter gets my slow brain cells firing and communicating with each other and that fine tunes the meter which makes it more easily triggered and so forth.
Vets, THANK YOU. And, with that, I will try to resist harassing or challenging any vets until Monday :)
PJBoosinger http://pjboosinger.viviti.com/ September 18th, 2009 06:02:42 PM
Interesting post and discussion, particularly since some, if not all, of Louie's recent problems can be directly traced to vaccination for rabies.
He'll be given a medical exemption next year, when his vaccination is next due, so I am not worried about that. However, I'm interested in the discussion of titers. This is the first I have heard that titering isn't yielding useful information about immunity. I guess that means that there's no choice but to follow the three year protocol, where that's allowed.
Louie's vaccination problems stemmed from 2 vaccines in 2 years, and I'm more or less comfortable with the three year protocol for my other dogs, which is allowable here in California. However, I was much more inclined to titer after Louie's experience, and am quite sorry to read that it isn't a practical solution for what is, for those few of us who experience, a very real risk.
Louie's Mom September 18th, 2009 06:48:24 PM
At least when it comes to animal vaccinations you don't have anyone up in arms over bogus autism claims!
zandperl September 18th, 2009 08:15:33 PM
zandperl: I know you meant that in a humorous way. But the fact is many children have serious life-threatening reactions and death due to vaccines. I work with a woman that lost her 4 mo. old grandson 8-10 hours after receiving multiple vaccine. His brain swelled and he went into respiratory arrest.
Another co-worker recently shared that a neighbor of hers young preteen daughter is now immobile shortly after receiving the guardisil vaccine. If you are a parent and affected, no statistic in the world will make you feel better, and no automatic government payout (from VARS) takes the place of your loved one.
Sad but true , and most never know about the risks prior.
Barb A./NH September 18th, 2009 08:50:20 PM
I live in AZ and found these interesting sites for my state:
http://www.azdhs.gov/phs/oids/vector/rabies/pdf/rabies2009.pdf
A chart of rabies cases by county and animal for 2009.
http://www.azdhs.gov/phs/oids/vector/rabies/pdf/Rabies2009map.pdf
A map of the state showing where each type of rabid animal was found and where the clusters are. I live way too close to that southern cluster to take any chances!
They also tell you what type of rabies certain species are infected with. Skunk, fox, and bat variants were the most common. And if you look, 3 horses have been infected so far this year!
JM September 18th, 2009 10:51:18 PM
Lisa: I am aware of this work and I sincerely hope it proves successful. I, for one, am always looking for ways to downgrade my vax frequencies.
Dr. Patty Khuly September 19th, 2009 07:42:36 AM
Louie's Mom: After a series of three [pre-exposure] rabies vaccines in our first year of vet school, one of my classmates came down with lupus. As a veterinary community we were convinced it was vax-related. So sad. So hard to prove. But it was reported. As a direct consequence, I can't believe there isn't one of us from the class of '95 who doesn't do his or her very best to minimize vax exposure.
Dr. Patty Khuly September 19th, 2009 07:46:08 AM
The most common and widespread wild animal reservoir for Rabies across North america is bats. Rabid bats have a disturbing habit of turning up in random, weird places, like inside houses. Their teeth are so small that a bite on a curious cat may go unnoticed if the owner does not see the incident, and there are cases of human rabies from bat strains where the victim was not even aware of a bite, but saw a bat in the house. I found a rabid bat flopping around on my back door step a few years ago fortunatately I got to it before the dogs or cat did (euthanised and then tested positive for rabies). Sure the risk is probably very low for any individual, but the consequences for the victim are severe. I don't really consider this fear mongering-just respect for the seriousness of the disease. Hopefully we will have good evidence for longer intervals for vaccine boosters-the problem with 5-7 year studies is that they are expensive and take a long time (at least 5-7 years)-so we will not have many different vaccines labelled and approved for those intervals any time soon. The reason very few humans in the US get rabies from domestic animals is because the vaccines work-like it or not. Go back 60 years or so to the time before rabies vaccination of pets was common and there were many hundreds more human rabies exposures and dozens more deaths every year, just as there are still tens of thousands of cases every year around the world-people are much more likely to be exposed by domestic animals, and are more likely to take wild animal bites seriously and seek treatment.
Skeptivet
Bartimaeus September 19th, 2009 01:39:00 PM
I don't view this topic as stating that rabies or any vaccine not important or worth the risk of unvaccination. What I and many question, is the frequency and number needed for lifetime immunity. Many feel that the number is "2" for any vaccine, with one later than a year of age.
Also, clinics worried about experienced owners restraining their own dogs? Lawsuits? Anyone can sue anyone for anything? Sure, if you can find a "lawyer"--- try to and then tell me.
Real simple solution, if there is great concern regarding "restraint", either bring a muzzle or offer one of the many hanging in the back room for the pet.---solved, no can bite.
Barb A./NH September 19th, 2009 08:59:21 PM
@Barb: i agree that there's no doubt as to the importance of rabies vaccination. and once challenge studies are completed and label claims are changed and laws revised, i am more than happy to increase the intervals between rabies vaccinations. (truth be told, i'd be a happy veterinarian if i never saw an adult dog/cat for a "vaccine appointment" ever again) one thing that has not been mentioned in discussion yet is that unlike any other killed vaccine on the market, rabies is only given one time to puppies (and kittens unless using Merial's Purevax, which is a live vector) and then a year later. there is probably minimal (if any) protection conferred by the initial vaccination as a killed virus cannot create its own natural anamnestic response. this is probably why most rabies vaccination "breaks" occur in patients who have only received their initial rabies vaccine. with the second vaccine happening a year later, there are probably still less antibodies created compared to a standard 3-to-4-week-apart vaccine protocol... just something to think about.
as far as muzzles, yes they can reduce the chances of biting, but patients can still sometimes nip thru the opening or slip the entire thing off... and they do nothing to stop the patient from kicking, scratching, thrashing around or otherwise acting like a lunatic. and all these behaviors can pose a risk not only to the humans involed (i've seen some gnarly scratches and some black eyes) but also the patient (i've heard reports of lacerated veins/bladders when a patient freaks out during an otherwise uneventful blood-draw or cystocentesis). but again, not every animal hospital is staffed like mine with experts at restraint. some are downright poor or even abusive :(
Dennis Leon, DVM September 20th, 2009 08:05:21 PM
Dr. Leon, I have not seen one reference to a confirmed case of rabies in a dog that has received at least 2 vaccines. If there is a documented case in the US, surely it has been publicized.
I wouldn't mind reading about a cat(s) that it has been documented in. Where, what state?
Barb A./NH September 20th, 2009 08:34:22 PM
Hm, I said I'd wait until Monday, so I will :)
PJBoosinger September 20th, 2009 08:36:01 PM
Barb: Just to clarify––the study I cite above lists one rabid dog with two confirmed rabies vaccines.
Dr. Patty Khuly September 21st, 2009 06:45:36 AM
yes, it would be pretty rare for a dog/cat not to be protected with its 2nd rabies vaccination for some finite length of time (though that finite length may be longer than the patient's life span in some cases). aubrecht estimated that 1 in 8 million dogs would fail to seroconvert after the 2nd rabies vaccination.
the results summary of the study that dr k cites in the original blog states:
"...A total of 264 rabid dogs and 840 rabid cats were identified during the study period. Thirteen (4.9%) rabid dogs and 22 (2.6%) rabid cats had a history of rabies vaccination. Of these, 2 dogs and 3 cats were classified as currently vaccinated. Overall, 6 animals (1 dog and 5 cats) had a history of receiving 2 doses of rabies vaccine in their lifetime, including 2 cats that were classified as currently vaccinated."
but if you read the actual results section, it clarifies the story a bit. the dog with 2 vaccinations received #2 after suspected exposure to a rabid skunk and died 8 days later. one of the two currently vaccinated cats was diagnosed with rabies 10 months after its 2nd vaccination. the other cat began displaying clinical signs of rabies 3 days after the 2nd rabies vaccine was given. the 3 remaining cats were not up to date on their rabies vaccination at the time of death. but two of the 3 received their 2nd rabies vaccine after exposure to a rabid animal. one cat got vaccinated at 1 year old, then boostered at an unknown age, and developed rabies at 8 yrs of age.
help change the way we do things by donating to the rabies challenge fund. i have.
Dennis Leon, DVM September 21st, 2009 01:56:14 PM
I would also add, as an apartment dweller, that even if no landlord has ever asked to see the rabbies tags I'm betting they can, legally, demand to at any moment. That's the main reason I keep my two apartment cats up on their vaccinations despite their very sheltered existence(well, that and I'm pro-vaccine for all creatures). My building is very pet friendly and, therefore, we have a pretty high density of cats and small exotics all in one place. My guess is that in addition to the landlord, a city or state agency could also demand to see proof of vaccination if a problem ever arose.
AnneT September 21st, 2009 01:57:29 PM
Just one more "scare" tactic to throw out there-this paper illustrates what can happen when public health measures fail to be taken. Human rabies cases in China went from about 150 in 1996 to over 6000 in 2005, due to very low vaccine rates, and transport of dogs as food animals from areas of high incidence to areas of low incidence. Canine-canine rabies spread has only been eliminated completely in the US for about 5 years, and still exists just across the border with Mexico. It would be a shame to follow Chinas example, even a little, because of unreasonable fears of rare sie effects.
Skeptivet
Bartimaeus September 21st, 2009 07:57:02 PM
Just want to thank Dr. Leon for bringing up, again, the rabies challenge fund. To my mind, having a dog who has had a debilitating reaction to rabies vaccine, there is no single thing we can do that is more important that getting the protocols changed so that dogs are vaccinated no more than they need. The only way to do this is to find the research necessary to prove that we can lengthen the times between vaccines. I hope everyone here who cares about this issue will find a way to contribute. The fund is struggleing right now, and could use your support.
http://www.rabieschallengefund.org/
Louie's Mom September 21st, 2009 11:58:18 PM
Sheesh... sorry for all the typos above. Must be late!
Louie's mom September 21st, 2009 11:59:24 PM
@Bartimaeus - The problem of such a huge rabies increase in China is not exactly that dogs aren't being vaccinated now when they where before - as they weren't vaccinated before and there's been an increase in the population of dogs since, without an increase in vaccination. The majority of dog's lives have never held much value in China. It's always been easier to just do mass killing than vaccinating, and that's what's always been done. It's only with the rise in income for a small set of people, along with a rise in the perceived status of having a dog, that the population of dogs kept in homes has risen. However, that doesn't mean that those people are getting good, complete medical care for those dogs. Even people with money often don't feel that a dog is worth spending any of it on anything other than whatever they feel is important (such as fancy grooming, but not decent food or medical care). Of course, this attitude certainly isn't only prevalent in China, as we mention all too often here. However, there is such a large reservoir of rabies in Asia, so the picture is different.
Since eating dog is also related to status, the keeping of unvaccinated dogs in city centers (ex. behind the fancy restaurants), in cages - and the shipping of dogs to and from various places, as you mentioned - leads to a higher possibility of tranmission to city dogs that have been abandoned as not worth the trouble (many status seekers toss their dogs out after a short time) that are wandering around the back of restaurants looking for food. None of these dogs have real value (except on a plate), so vaccination isn't going to happen. And no matter that the increased incidences of mass kills are finally being reported worldwide, nothing is going to change because the dogs aren't valued.
Lastly, in a country that jumped from poor serfs ruled by feudal overlords to poor wage slaves ruled by corporate fatcats, there was never an agrarian boom that was based on the worth of the farmer and his crops. In the US and Europe, the value of increasing yields by better care (not going to debate the details) of food animals - especially in putting value on medical care - didn't happen in China. How many ag colleges are there? How many veterinarians? How much is public health - in any aspect - important in China? Changing the whole attitude of a behemoth of a country is the problem. Vaccines are available. What they aren't are valuable.
KateH September 22nd, 2009 10:19:43 AM
Dr. Leon: Thank you for that. It's obvious that two vaccines does not necessarily mean the second vaccine was applied prior to rabies exposure. It's also one of my big pet peeves that plenty of vaccine clinics and less-than-careful veterinarians continue to vaccinate sick pets. We cannot expect a normal vaccine response in these cases. Pet owners need to know that pets who are less than well at the time of their vaccines may not be well served by them.
Dr. Patty Khuly September 22nd, 2009 11:34:32 AM
@KateH
I do realize that the situation in China is not identical to the situation here, and we are a long way from the type of problems they are having. I merely brought that report up to illustrate how effective our public health efforts (including rabies vaccinations) have been hand how bad it can be when such eforts fail. I can certainly appreciate the fact that we tend to value our dogs and cats much more than most animals in China are valued, and I am grateful to live here and be a veterinarian here. It is just that those at the extreme end of the antivaccination movement, on both the human side and the veterinary side would like to ignore the huge benefits we get from vaccines-arguably the safest and most effective intervention we have in medicine, even when the potential side effects are considered. This does not mean we cannot improve vaccines in both effectiveness and safety, but those improvements are liekly to be slow and incremental at this point, and the risks to both human and animal health of reduced vaccination rates are significant.
Bartimaeus September 22nd, 2009 09:29:57 PM
Dennis, We were talking about restrain in relationship to the possibility of getting rabies from a bite which lead to the muzzles discussion. When a muzzle is properly fitted, NO, they can't bite through it. In addition to that, the risk of it being slipped out of is easily dealt with by using side straps to a harness. Oh, yes, "anything" can happen but that you now want to get into the possibility of being scratched just tells me you're basically afraid of all your patients. Exactly how high is the risk of contracting rabies from a scratch?
Any professional who would use "scare tactics" merely makes themselves look embarrassingly unprofessional! In addition, it damages the credibility of the profession.
PJBoosinger September 22nd, 2009 09:42:23 PM
Ms. Boosinger-
sure. and condoms never break, seatbelts will save me from every crash, and levees never let water through. muzzles are a tool used to reduce the risk of getting bit. anyone who foolishly believes that it is *impossible* to be bit when a muzzle is properly fastened has clearly never worked in this profession -or at least not with aggressive dogs and cats. sure, a muzzled patient can't grab my arm, but they can still potentially nip my pinky or nose or ear lobe with their incisors. (unless they're wearing a basket muzzle) i've seen it happen. they can also spit, slobber, and project their saliva across the exam room. i've had my staff clean the ceilings of this mess. now what are the chances of getting rabies after being exposed to infected saliva? somewhere between scratch (prety low) and bite (pretty high). i'm not afraid of any of my patients. rather, i respect the fact that they are not humans, cannot be rationalized with, and are often unpredictable.
YOUR arrogance when it comes to the safety and health of my staff, patients and clients astounds me. your level of mistrust and the fact that you think you know more than every doctor makes it impossible for you to ever find a veterinarian or physician who can actually suit your needs. Please reserve your advice on how to run my hospital until after you graduate from veterinary school.
-Dr. Leon
Dennis Leon, DVM September 23rd, 2009 12:35:15 PM
@Bartimaeus, I agree with your statement of "It would be a shame to follow China's example, even a little, because of unreasonable fears of rare side effects." What I was trying to point out is that, unless we have an apocalypse, I cannot believe that the US will ever have a rabies problem like China's. At the risk of being declared prejudiced, our society places a higher value on how science and medicine can and should be used to improve the lives of its members than China does. I'm not saying the actual process of medical care delivery is equitable, nor the economics of wealth, however, there is at least the willingness on the part of government to make public health an important part of its responsibilities. China, not so much.
KateH September 23rd, 2009 04:10:39 PM
Dennis Leon, DVM said: "....but they did teach me "the internet provides just enough information to make a client a pain in the butt." An ophthalmologist once told me that even though patients that used the Internet asked more questions, he wished more doctors made use of the Internet for research. He thought they would be more effective doctors if they did so.
Carl September 23rd, 2009 04:50:40 PM
Oh, my, we're being formal Dr. Leon? Well, in that case, you may address me as "Dr." as well since I'm sure you know what the "D" in J.D. stands for. BTW, I don't give a flying flip how you run your practice as I'd never set foot in it for oh so many reasons, most of all your short temper that doesn't (IMO) bode well for animals. And, where exactly did I do that in the first place? I did notice you didn't answer my final question on your blog and I'm just guessing you've returned to your original editorial pre-approval of comments ways so I won't even bother.
Old Saying: When the facts are on your side, pound on the facts. When the law (or science or medicine) is on your side, pound on that. When neither is on your side, pound on the table. You have a big table, pound away :)
And, now that the enormous water leak that sprang up in my condo a few days ago is in the hands of the association instead of mine and I'll no longer be commuting to tend it, perhaps I'll get some rest and be able to get my own blog tended.
PJBoosinger http://pjboosinger.viviti.com/ September 23rd, 2009 09:07:52 PM
ah yes, the JD degree. it's the only doctorate degree i can think of that only takes three years to earn and rarely does anyone address their attorney as "doctor," but i can call you dr. boosinger if you like.
i'm not pounding on any tables. i'm just spewing facts -facts that you don't see because you're on the other side of the exam table (and you choose not to see any viewpoint aside from your own pre-determined 'correct' one). i'm actually a pretty calm, laid-back sorta guy ...but you push all the right buttons ;) re-read all of your comments, and you will see who likes to fly off the handle more.
as for not addressing your question on my blog ...i did. did you read my response? nothing was edited on either side, and all of your comments coast right on thru (they only get moderated the first time around to weed out spammers). so if it's not up there, the blog never received it. i'm more than happy to have your counterpoint up there for the world to see. there are a couple of additional responses to your previous banter, though: http://levittownvetblog.com/general/clients-stop-playing-doctor/
good luck with the leak.
Dennis Leon, DVM September 24th, 2009 04:00:27 PM
"ah yes, the JD degree. it's the only doctorate degree i can think of that only takes three years to earn and rarely does anyone address their attorney as "doctor," but i can call you dr. boosinger if you like." ROTF, You're the one who made a point of signing your previous entry "Dr. Leon" after addressing me as "Ms. Boosinger". Of course, I expected your commentary on my degree and you thinking it would bother me tells me you haven't read some of my earlier comments directly on that point. Still interesting to see that "I'm a REAL doctor" thing in this day and age. I got a good education in that one back when "real doctors" didn't want to address my PhD mother as "doctor". Your degree is no more terminal in your field these days than mine and mine is a doctorate whether you approve or not :) You are correct that we don't generally get called "doctor", we think it's poor taste to shove it down people's throats and that has its own history within my profession. In fact, most of my clients and others address me by my first name as is the custom of the day. Interesting how many doctors still want to be addressed formally while addressing others informally though. And then there are those who are informal until there's an issue or their offended and then... super, dooper all formal. So much for "I can take it, blah, blah..." ROTF!
Mostly, I just banter here. If you think I was aiming for your "buttons", you should check the sensitivity level on those buttons. When I do punch buttons, I make no bones about it and generally put an arrow right through them. I'll likely put you on my "scroll past" list and then you can be sure I'm not aiming at your buttons.
PJBoosinger September 24th, 2009 06:26:48 PM
PJ, I wonder about your idea about 'banter' in that it is pretty damn obvious to everyone here that you aren't trying in the least to be any more than 'barest bones' polite when you start defending or attacking a point that been made by someone else. Oxford dictionary - banter (n. & v.) n. good-humored teasing, v. 1. ridicule in a good-humored way, 2. talk humorously or teasingly. Banter is something that friends engage in when they don't want to be overly aggressive talking about subjects that they don't see eye-to-eye on.
You and Dr. Leon aren't going to be friends so you aren't bantering with him. You don't banter with Dr. K. very much, although there have been one or two times when you saw eye-to-eye with her, and then it could be said you were bantering. Mostly, with any vet, and vet staff of any type, you are confrontational and contentious, with an attitude ranging from barely polite to actually rude. It's obvious that you're a well-educated person to a number of fields, but your social intelligence is not as complete as your academic intelligence. There are many times when the information that you are so good at researching is interesting and valuable, and I'd hate for you to stop bringing all that, along with your friendly opinions to the comment section, but for cryin' out loud, try a bit more honey instead of vinegar. It won't make you a sell-out or less real, just a bit nicer - and dog forbid, would that kill ya?
KateH September 24th, 2009 07:08:28 PM
"social intelligence is not as complete as your academic intelligence" I'll cop to that. "would that kill ya?" Maybe. I presume others will scroll past or ignore what they want to get what they want, just as I do, as is the nature of the internet. Personally, I find it a pain and waste of time to read through sugar coating to get to meat but everyone has their own style so... I'm not under the impression that blogs are self appreciation societies but maybe I misunderstand their nature.
I used the term banter because it was the one Dr. Leon used. I dsiagree with you definition of banter buy you're entitled to use it as you see appropriate. I see it's definition and conotation more broadly than that but, if you prefer, I'll use the term "debate" in the future.
PJBoosinger September 24th, 2009 07:45:57 PM
dr. boosinger and i are actually secretly in love with each other. that's why we bicker/banter/debate like this ;)
but seriously, dr. b., i was just pokin' fun at your juris doctor degree -more for the entertainment of others than to bother you, but it seems like i hit one of your buttons as it resulted in 12 lines of rebuttal. it's just like veterinarians often joke "real doctors treat more than one species." i like that one a lot too :)
i agree with kate that you are obviously an excellent researcher who can bring a lot to the table at a blog like this ...but the attitude that comes with it just wears thin really quickly. and you are correct in that i pick & choose who can call me dennis and who should address me more formally. really, as long as you don't call me "denny" i'll be fine!
wow, we drifted far off topic here! back on track:
*vaccinate your pets for rabies,
*make an educated decision on vaccine intervals,
*and don't get bit!
Dennis Leon, DVM September 24th, 2009 08:32:44 PM
Ok, PJ--got the drift and added my 2 c. http://levittownvetblog.com/general/clients-stop-playing-doctor/
I'd laugh over it, but it is really kind of sad, who thinks what, of themselves and others. Must be this social hierarchy thingy or left over college ego. I haven't bought into it for over 10 years, but that may be an age thing too!
Barb A./NH September 26th, 2009 10:18:37 PM
Hi Dr. Khuly,
I just wanted to let you know that we linked to this blog post today. I loved it! Here's the post: http://www.petfinder.com/blog/2009/10/14/vaccine-reactions-what-your-ve/
Jane - Petfinder.com Blog October 15th, 2009 06:47:53 PM
This was an excellent post, but I'm another who does not need convincing. Though I have never experienced it first hand (thank goodness,) I have read accounts of what happens to an animal who contracts the virus. I would never, ever want one of my animals to go throught that! Not a chance! I'd rather take the (small) risk and vaccinate them regularly. (I opt for the 3-year vaccines.)
Another incentive for me is that my county levies a $500 per animal fine against any owner who does not keep their animals' vaccines up to date. With 9 cats, that's a huge incentive, believe me! I have a folder in the very front of my file cabinet drawer that holds all of their certificates. Every time someone's shots are updated, so is the folder. Out goes the old certificate, in comes the new one. I'm diligent about that.
My cats are all indoor-only cats, but we all know that accidents can happen. Sometimes, they panic or see an opportunity and can slip out the door. Luckily, the few times this has happened, I've been able to get them back in, but goodness forbid if they truly got away!
My county--and even my city--has seen a number of rabies cases the last few years. Most of the ones I've bee aware of have been bats, but I'm sure it's been seen in dogs and cats locally, too.
I think it's better to be safe than sorry on this one, personally.
Jen M. October 23rd, 2009 12:41:19 PM
GREAT THOUGHT
Dissertation
jessica smith February 9th, 2010 07:50:20 AM
Add Commment