(2000) To Vaccinate or Not to Vaccinate, That is the Question, but it Does Not Help Get to the Answer! ... Nick Thompson BSc.(Hons), BVM&S, VetMFHom, MRCVS. (Nick runs his own independent Homoeopathy, Acupuncture and Nutrition referral service for companion animal species from his home in Petersfield, Hants. One of four children born in Oxford to a doctor father and midwife mother, animals became a way of life with a family move to the Cotswolds when he was 5 years old. Professional qualification was obtained at The Royal (Dick) School of Veterinary Studies in Edinburgh where he also gained an Honors degree in Pathological Sciences, concentrating on immunology. Employment commenced in a large and small animal practice in East Yorkshire where his thoughts began turning more and more towards the holistic approach to veterinary treatment. A few years later saw the opportunity to become part of a team at a newly established practice near Chichester which integrated alternative and conventional therapies. During his four years at this practice, Nick gained memberships to the Faculty of Homoeopathy and International Veterinary Acupuncture Society. Visit Nick at his website: www.holisticvet.co.uk) I don't know about you, but I'm amazed at the amount of incontrovertible evidence that has been brought to bear on both sides of the vaccination debate. Much of it completely contradictory. What is the truth? What is the best thing to do? Or maybe you're thinking you'd love to not vaccinate or reduce the frequency of vaccination, but because of race regulations or kennelling rules, you cannot. Let's explore the argument. Let's look at the pro-vaccination side, the no-vaccination-at-any-cost side and see where the middle ground lies. For it is in this middle ground that we can do the best thing for our dogs while placating our feelings of guilt or confusion at the conflicting reports on both sides of this vital issue. For Vaccination The argument for vaccination runs something like this: For the last 250 years we have been protecting ourselves and our animals from infectious disease by inoculating ourselves with organic material to stimulate the immune system to protect us from specific infection. We and our animals have become more and more healthy over those 2½ centuries with less and less of the infectious diseases being reported. Today we have more or less controlled infectious disease in developed countries and have even, apparently, wiped Smallpox from the planet. Canine vaccines, the story goes, have eliminated Distemper as a scourge and reduced Parvo to something only really seen in areas where human health is generally sub-optimal, where dogs are poorly looked after and freely interact with large numbers of other unhealthy specimens. Reported reactions to vaccines are negligible compared with the number of animals protected from these killer diseases, we are told. You might as well 'give them everything every year, just in case' is the prevailing attitude among vets, owners and manufacturers as evidenced by the growing number of all-in-one (polyvalent) vaccines and the difficulty in getting individual component vaccines. The most convincing argument FOR vaccination is that we all do it every year and yet we don't seem to have many problems. So, are you convinced? Read on. Against Vaccination The Antis, as I shall call them for convenience, not meaning to be flippant in any way, but merely trying to easily distinguish between the Fors and those against, see things differently. They maintain that infectious disease goes in cycles, as evidenced by the recent flu epidemic ['Oh', they say, 'if vaccination is so effective, why do we have problems world wide with Flu in these days of vaccination protection and high technology?'], and that if you start vaccinating after the height of an epidemic, you will see massive reduction in morbidity and mortality anyway. If you combine this with improving sanitation and housing, you get a seismic shift in health whether you vaccinate or not, they suggest. Smallpox, the Antis irritatingly point out, was eliminated not by immunisation, but by identifying and isolating cases to prevent rampant spread. Sierra Leone is a case in point. In the late sixties, Sierra Leone had the highest rate of smallpox on the planet. In January 1968, they began its eradication campaign, and three of the four largest outbreaks were controlled by identifying and isolating cases alone, without immunisation. The same case is true with canine epidemics, they maintain. Distemper was dying out itself by the time an effective vaccination came along and both it and Parvo have been massively helped by the general rise in the standard of living over the last 50 years. Reactions to vaccines are rarely reported. There is a system in place where a 'yellow form' for 'Suspected Adverse Reactions' may be used, but vets a) do not look for problems after vaccines and b) do not have time, very often, to fill in a form when they have a busy day to get through. This is, unfortunately, human nature. Vaccination is held as being protective for these killer diseases. Most of them are not killers anymore. Even simple intravenous fluid therapy can now save hundreds of the type of cases that would have sadly perished even 20 years ago. Once the dog has had the disease, they are fully, solidly and naturally immune. Also, even the vaccine manufacturers admit that the vaccines are 96% effective as a small subgroup of the population just do not respond. If this is combined with the number of dogs who are on steroids each summer for pruritic (itching) dermatitis who get vaccinated before the owners put them in kennels in June/July, the number of bitches vaccinated during oestrus, and all those animals with chronic disease such as atopic dermatitis or arthritis, all the aged animals, whose immune systems are reduced due to old age (as evidenced by the increasing incidence of warts, for example), then the proportion of sub-optimally vaccinated animals could be rather large! Parvo, Lepto and Adenovirus (the hepatitis and Kennel Cough virus), Parainfluenza and Distemper are transmitted via the oro-nasal route, the Antis point out. So why do we vaccinate them through the scruff? Route of vaccination is important. That's why you were given your Polio vaccine by mouth on a sugar lump (or was it because injecting sugar lumps can break the syringe?!). If you expose the body to antigen (anything that can be recognised by the immune system) via an inappropriate route, you can get problems. Similarly, if you mimic the natural route of infection, as in the intranasal vaccines, immune response is quick and the side effects are few, although there is some doubt as the effectiveness of some of these vaccines. As for the argument that we don't see problems resulting from vaccine, please just look about you. Hypersensitivity disease is rife. The amount of immune modulated disease seen today is unprecedented. OK, it may not all be vaccine, but when one is giving annual multivalent vaccines to hypersensitise the immune system, it must be part of the picture. How many dogs have we that have chronic low level itch? And what about persistent ear problems? Not to mention those animals that constantly lick their backsides or their feet. All this, in my opinion, is intimately related to vaccine and diet. I know because I see it daily and often have almost miraculous effects simply by changing diet away from processed food. I digress...feeding is another of my soap box subjects. The Reality of Vaccination So it seems that there are pretty good arguments on both sides. I think it would be safe to say that we currently do not know enough about our canine vaccines to assume they are completely benign in all but their specific function. It is easy to spot an association if the reaction is immediate. The longer the delay between the vaccination and the reaction, the less likely we are to see the problem without looking very carefully with large well-designed studies. A discussion at the British Small Animal Veterinary Association in April this year, including such dignitaries as Prof. Ros Gaskell from Liverpool University, Prof. Richard Ford from North Carolina State and Mr David Sutton from Intervet UK included the following comments, reported in the Veterinary Record of the 15th April 2000. Prof Gaskell informed the group that 'the difficulty was that there was very little information on the overall disease prevalence in small animals and, accordingly, on the potential risks associated with vaccine'. Also, apart from the animal welfare and cost issues involved, it was very difficult to produce laboratory trials to support a long duration of immunity and so the duration of immunity given on most data sheets was just a year. For multivalent vaccines, the situation was further complicated. For these products, the duration of immunity represented 'the lowest common denominator of the constituent components'. Prof. Ford continued by posing the question 'Are we now causing the disease by vaccination?', meaning Immune mediated thrombocytopenia, polyarthritis and anaemia (he did not mention atopic dermatitis or immune mediated thyroiditis, strangely). He went on to suggest all these diseases 'may be potentially associated with vaccines'. [This sounds like the tone that was taken on Organophosphorus compounds and Global Warming before the association was so obvious a two-year-old could see it, doesn't it?] He went on to state that 'as we add more antigens to the system, there is probably going to be more risk'. Mr. Sutton conceded 'different vaccines performed very differently in the face of maternally derived immunity and also in terms of how long their effects persisted'. He added that 'while, overall the levels of suspected adverse reactions had increased over the years - due to greater awareness and increased number of products on the market - there had been no increase in the percentage of reports that were vaccine associated'. As we have seen from the previous arguments, 'If you don't look, you will not find'. I personally take this last offering from Mr. Sutton with a pinch of salt. The vaccines you get from year to year are different; new cell cultures are used, new preservatives, antibiotics and adjuvants (to enhance the immune response [to Parvo!?]) are used, leaving the consumer and vet hopelessly uninformed. Vaccine manufacturers vary in their recommendations for their products. Some recommend annual boosters for all parts of the pentavalent (DHPPiL) vaccine, some recommending that Distemper and Adenovirus/Hepatitis is lifelong and some recommending Distemper every second year. All in all, it's a bit of a mess. And we have to do something for the sake of our sanity and the health of our dogs. The Middle Ground - Until We Know More I'll come to the point and try to be as precise as possible with this part as I'm sure you're sick of the vagaries of the scientific arguments. What I'm going to suggest is plain common sense as it seems this is the only thing missing from the above mud fight. 1. Pups should be vaccinated at about 12-16 weeks to allow maturation of the immune system. During this time, they should only have access to animals of known history. If it is possible to delay further, so much the better. 2. Pups should be given one shot of DHPPiL initially and then followed up with Lepto alone two or three weeks later. If it is possible to split the initial DHPPiL (PL, then DH Pi for example), so much the better. 3. After this, animals should either be: a) titre tested every 3 years to assess adequate immunological protection or b) vaccinated with the pentavalent vaccine every 3 years (as per many Vet Schools in the USA). 4. Animals over the age of about 8 years should be considered for no longer vaccination. Either they are fully immune or their immune systems will no longer take the vaccine, so what's the point? For the sake of not taking up any more of Gangline space, I will not put in a list of references, but these I will supply if you contact me by email: nickthompson@holisticvet.co.uk