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10/31/09

Canine Influenza- general information on the disease is foung in the Pet Library type in the title and search.

There has been many questions about the outbreak of Canine Influenza and whethor of not to vaccinate.  Currently we are not recomending vaccination due to recomendations by many leading experts.  We are going to post excerpts from many blogs by people that are knowledgeable in the field.  Hopefully this will help all to understand a disease that is being put in the spotlight.

>>> What are the opinions, especially in a "normal" boarding situation. <<<

In talking with folks at diagnostic labs, the prevalence of it does not appear to be that significant. In addition, it is generally a mild self-limiting disease. Perhaps I might consider it in dogs at very high risk, e.g. boarding frequently, going to many shows, traveling, but it is not something I personally would consider as part of routine vaccination for all dogs - FWIW...

Melissa Kennedy, DVM,PhD,DACVM
Clinical Virologist
University of Tennessee
College of Veterinary Medicine

Unless there is FLU in that locale, I wouldn't recommend general vaccination for all boarding animals. If it is done (as mentioned in the discussion) the entire series must be completed prior to expecting protection. Even then, the vaccine will not prevent the dog from becoming infected, showing some signs, or shedding the virus. The vaccine is marketed to reduce severity of signs and duration of coughing only.

>>> They need to understand, and probably don't, that vaccination "coming in the door" will do nothing as it takes at least 2 vaccines to establish protection (such as it is). That means at least 3-4 weeks after the first vaccination <<<

Per the manufacturer 'protection' occurs 10 days after the 2nd booster, which can be given 2-4 weeks after the first. I don't know if the kennels understand this, but we are telling our clients this .I just wanted to let ya'll know that we're telling our clients the first vax doesn't guarantee protection, and are recommending vax start at least several weeks before boarding.

Christine Kellogg, MS DVM

Wow - I wouldn't go so far as to recommend it to all dogs receiving Bordetella. Quite a few clinics routinely vaccinate all dogs for Bb. And the other groups that issue vaccine guidelines (AAHA for example) haven't classified it as "noncore" yet. In fact, sometimes vaccines fall into the "not recommended" category if there are questions about efficacy or safety. I think the vaccine is too new for AVMA to take a position on it - after all, it's still only under conditional license from USDA.

Craig Datz, DVM, DABVP

Directly from the backgrounder:
"The canine influenza vaccine is a non-core vaccine, and is not recommended for every dog. In general, the vaccine is intended for the protection of dogs at risk for exposure to the CI virus, which include those that either participate in activities with many other dogs or are housed in communal facilities, particularly where the virus is prevalent. We're not recommending it for all dogs receiving Bordetella--we say the risk groups are similar, and dogs that MAY benefit from the CI vaccine are those already receiving Bordetella.

We're not recommending it at all--we're saying it's a non-core vaccine at this time, and dog owners should consult with their veterinarians

Kimberly Anne May, DVM, MS
Assistant Director, Department of Professional and Public Affairs
Communications Division
American Veterinary Medical Association

We are using the CIV vaccine for majority of dogs who board or have exposure to larger numbers of dogs (e.g. shows, etc.). We saw a confirmed outbreak (serology & PCR) of canine influenza in a local boarding facility that infected 65% of dogs who were boarded over a 2 week time period in June 2009. None died. Most had mild to moderate upper respiratory symptoms that persisted for up to 4 weeks. A couple needed more intensive care (seen at other area veterinary hospitals). Some kennels in our area are now requiring the influenza vaccine just as they require Bordetella because it does seem to be present in our region.
I believe that PCR/serology information is important because around the same time we were seeing our cases of influenza, a shelter in Philadelphia was reporting numerous fatalities from peracute respiratory disease that was reported to the media as presumptive influenza. It turned out to be Streptococcus equi ("Strep zoo"). So the great hubub in our area (Allentown, PA region) with clients concerned their dogs were all going to die was somewhat short-lived.
--Dan--

*****************
Daniel M. Smith, DVM
Alburtis Animal Hospital
Alburtis, Pennsylvania, USA

The vaccine is new, only conditionally licensed, and a killed product that requires a booster. So it's difficult to recommend it for all dogs but probably useful in certain situations. I would consider offering the vaccine to clients who have dogs that board, travel a lot, visit dog shows, etc. At this point, we don't know if the vaccine provides "sterilizing immunity" and is only labeled to help control the disease associated with infection. So vaccinated dogs might still get a mild case and could shed the virus.

We do know that hardly any dogs have pre-existing immunity to influenza so when it strikes in an area, lots will be exposed and become infected.

Craig Datz, DVM, DABVP
University of Missouri
College of Veterinary Medicine

Consultant, Infectious Disease/Immunology, Parasitology

Very interesting thread. I practice in Colorado Springs, CO, and we had a city-wide outbreak last summer and again over the Christmas break. We haven't seen a single case of influenza this summer. In fact we have seen very few "kennel cough" cases at our practice this summer. I've talked to other DVMs in the area and they share our experiences. We met with the Schering rep last week to discuss the vaccine and I shared our experiences with her. Unfortunately the company has already marketed the vaccine t the kennels and the media before talking to all the veterinarians! Many of us have been caught off guard, as many kennels are now requiring the vaccine for boarding. While I understand the kennels are a business and they have an interest to protect themselves (and the pets they board), I also feel the kennels and media are dictating vaccine guidelines (as someone already has stated). Another article was published this weekend in our local paper by another DVM stating all outdoor dogs should get the vaccine. I disagree with this recommendation but I guess the debate has begun. My issues/questions right now are: how long are dogs immune once exposed to the actual virus? I don't think anyone knows for sure, but it's interesting that we haven't seen a single case this year (at least at our practice as well as some others). If we have another outbreak next year, is this current vaccine going to effective? We know that human influenza changes yearly, which is why there's a new vaccine each year. What about canine influenza? Is the vaccine going to change the normal threshhold of shredding and infection from what we see now? I have no idea, but I do know no vaccine is 100%, and this one certainly isn't based on the company's own data. What is the incidence of vaccine reactions going to be? Sure, the company said they've seen no reactions in their studies, but 400 dogs isn't a lot in my mind considering the population? Do the risks of the catching the disease and having severe symptoms outweigh the risks and benefits of the vaccine. I guess time will tell. Interesting debate indeed!

Todd Harrell DVM

Just thought I'd add this to the conversation and information here. This was posted to the ACVIM Listserve by Dr. Richard B. Ford from NCSU:

"I have recently met with Dr. Teri Wasmoen during a vaccine meeting in
Madison WI. She's a lead scientist on this vaccine for Intervet
Schering-Plough and one of the co-authors on a recently published paper on
this disease/vaccine.

There are no studies outside of the company that have assessed efficacy.
It is a killed (adjuvanted) vaccine. Therefore, immunity is
NON-sterile...ie, the vaccine does not prevent infection nor will it
completely prevent shedding.

The challenge studies reviewed during the meeting indicate that the
vaccine does mitigate severity of signs and shortens the duration of
shedding in vaccinates (which is naturally short...7-8 days). Clinical
illness still developed in a small number of vaccinated dogs post
challenge.

CIV infections have been reported in at least 30 States + District of
Columbia...probably more. But infections are largely limited to
shelter-housed dogs.

This is clearly not a CORE vaccine. Use is probably best limited to
cluster housing situations where the risk of infectious respiratory
disease is greatest."

Rich Ford
NCSU

This is a killed virus vaccine that apparently provides non-sterilizing immunity. Information says that it "lessens the frequency and severity of lung lesions, reduces viral shedding, and reduces duration of coughing." In other words, it does not prevent infection nor does it completely prevent clinical signs of infection.

Definitely NOT core. Maybe something to consider for shelter animals IF there is an outbreak in shelter.

It's nice to have a vaccine available in case this disease becomes more of a problem in the future but for now, it's a non-issue except for rare cases occurring in group housed environments with less than ideal husbandry.

I cannot recommend it for my household pet patients at this time.

Alice M. Wolf, DVM, DACVIM, DABVP

 would only use it in a dog at very high risk for exposure - travels to shows alot, etc. While the virus is present across the country, the extent of its involvement in outbreaks is really not clear. It is generally mild, with pups at highest risk for more significant disease.

It is a killed vaccine, which means it is likely adjuvanted. And previous studies have shown that multiple injections at a single visit is more likely to be associated with adverse reactions; thus adding in another vaccine for yearly visits by adding in k9 flu is not something I would do routinely.

Melissa Kennedy, DVM,PhD,DACVM
Clinical Virologist
University of Tennessee
College of Veterinary Medicine

VIN is great. Rep dropped by the info, somewhat scared the fire out of the staff. I think this is a great point: >>>Shelter medicine vaccination and preventive care may differ from household pets. Hopefully we'll see some publications about vaccine efficacy, onset of protection and maybe duration, side effects, any interactions with other vaccines or commonly used medications, etc. <<<
At this point, it seems to be a vaccine in search of a disease, for most household pet veterinarians. I just can't see that the potential risks (side effects /interactions, etc. mentioned above) make it worth vaccinating our household pets across the board at this point. I think I'll take a wait and see approach on this one. Have yet to diagnose one, may have seen a few for sure. IF we start diagnosing it more, then I'll revisit the vaccine I suppose. Looks like it might be a great product for shelters, and if the shelters adopt it then there should be even less of a need for it out here in the general population. One catch is what the ABKA (American Boarding Kennel Association) is going to do about it........we had trouble for a while getting our triennial DHP/P accepted by the boarding kennels because of ABKA's recommendations....if they jump all over this, it may be a problem.

Guy G. Mathews, DVM
Kyle Animal Hospital
Kyle, Texas

In terms of business, whenever a company introduces a new vaccine, the sales and marketing force goes all out to try to get a foothold in as many clinics as possible. It's called a "product launch". In terms of us making decisions for our patients in the real world, we should consider prevalence of disease, lifestyles of our patients, economic factors (would an additional vaccine fee be acceptable for most clients?), and risk:benefit ratio (are there any local or systemic side effects of the vaccine, or any acute or delayed problems reported?).

Fear of disease is commonly used as a marketing tool (for both human and veterinary products). I prefer to use an unemotional, scientific approach based on data whenever possible (a la Mr. Spock).

Craig Datz, DVM, DABVP
University of Missouri
College of Veterinary Medicine

Consultant, Infectious Disease/Immunology, Parasitology