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2008 Rabies Vaccine-JAVMA Report Adverse Reactions in Dogs


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If the dog has antibodies to the disease (a titer) how would that not indicate immunity?
Where is the report/study that shows the results from the "titer test" being run really means the dog is protected against a viral challenge. You're assuming the test results really mean something; I'm not sure this has been proven. Not all tests (from different manufacturers, different testing methods, or different disease) perform equally well.

 

Here is a report showing two titer tests yielding different results for the same serum samples for non-vaccinated dogs from a rabies free island. With one test none of the dogs were seropositive for rabies while the other indicated 10% of the dogs were seropositive.

 

A rabies serosurvey of domestic dogs in rural Tanzania: results of a rapid fluorescent focus inhibition test (RFFIT) and a liquid-phase blocking ELISA used in parallel

Epidemiology and Infection (1999), 123: 157-164

 

Mark

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That is precisely what The Rabies Challenge Fund is doing -- financing the 5 & 7 year challenge studies according to the USDA vaccine-licensing standards upon which state laws are based.

This is great!

 

estimated that the adverse reaction rate of serious nature to rabies vaccinations is in the order of 0.38- 0.50% , with another 1-3% of vaccinates experiencing less severe reactions of the millions of dogs that must be vaccinated by law annually

 

Who made the estimate, how did they make it, what is the degree of confidence in the estimate, and what is a severe reaction? - I'm not being flip or contrary -- these are questions that, as a person trained in research, I need to know to validate this statement.

 

But this point is really moot - I agree that serious adverse reactions are a compelling reason to do more research.

 

If it's your child, your parent, or your dog...does it matter if it's 1, or 1 million?

I think I already addressed this. It does matter to the individual - deeply, I'm sure (I just lost a beloved dog recently - I DO understand how it feels to loose a pet). However, that's not how public policy decisions are made (must weigh all possible effects, good and bad) and this statement also ignores the fact that we don't KNOW 1) that the vaccination caused the death or 2) that a particular titer would have been indicative of immunity.

 

I've got a related ethical question for you -- Is it OK for some people to not take the risk of immunizing their pets and, instead, let others "shoulder" the risk for them while they benefit from herd immunity? No one ever brings this up . . .

 

Kim

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I've got a related ethical question for you -- Is it OK for some people to not take the risk of immunizing their pets and, instead, let others "shoulder" the risk for them while they benefit from herd immunity? No one ever brings this up . . .

 

If the vaccines provide protection, and you believe in them and take them, what are you shouldering if someone else doesn't take them? The only "at risk" individual would be the unvaccinated one...correct? That makes physiological good sense. After all, if the vaccine isn't going to protect you from the disease, why would you take it?

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Who made the estimate, how did they make it, what is the degree of confidence in the estimate, and what is a severe reaction? - I'm not being flip or contrary -- these are questions that, as a person trained in research, I need to know to validate this statement.

 

Kim, if you look back at my post, it states that the quote is from Dr. W. Jean Dodds. She is a trained veterinary vaccine research scientist who has been involved in rabies vaccine research for over 40 years. She is also a DVM and practicing clinician.

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Mark,

 

Could you, or someone knowledgeable on the subject, address this question from Lenajo?

 

I've been titered for Hepatitis B for example, and that was adequete by medical standards to indicate I needed no further vaccination. Is it not the same in dogs?

I'm intrigued by Mark's skepticism about the usefulness of titer results. I too got a Hep B titer test after my Hep B vaccinations and "passed". Are you (Mark) saying that what's lacking for dog titers is a study showing what level of antibodies confers what (statistical) level of immunity, versus such studies having been done for, e.g. human Hep B? If so, do we not need such studies for common dog vaccs where adverse reactions are a concern? Or am I misunderstanding you?

 

BTW, I expect I speak for many lurkers when I say that I really appreciate the intelligent and reasoned debate currently going on in this thread, and particularly the contributions of those of you who have significant relevant expertise to offer.

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Are you (Mark) saying that what's lacking for dog titers is a study showing what level of antibodies confers what (statistical) level of immunity, versus such studies having been done for, e.g. human Hep B? If so, do we not need such studies for common dog vaccs where adverse reactions are a concern?

 

Alaska,

 

Perhaps I can answer part of your question, although certainly not attempting to speak for Mark, who is very articulate and will probably respond himself.

 

Peer-reviewed serological studies on the canine rabies vaccine have already been conducted by Dr. Ronald Schultz of the University of Wisconsin School of Veterinary Medicine. Those published studies demonstrated that dogs had antibody titers counts at levels known to confer immunity to rabies 7 years after vaccination. Those results were incorporated into both the 2003 and 2006 American Animal Hospital Association's Canine Vaccine Guidelines.

 

Serological studies on the distemper, hepatitis and parvo vaccines have also been conducted demonstrating a mimum duration of immunity of up to 15 years. Those results are also incorporated into the 2003 & 2006 AAHA Guidelines as well as the Duration of Immunity to Canine Vaccines: What We Know and Don't Know linked below.

 

You can see the results of those serological studies on the canine vaccines at the links below.

 

Duration of Immunity to Canine Vaccines: What We Know and Don't Know, Dr. Ronald Schultz http://www.cedarbayvet.com/duration_of_immunity.htm

 

The 2003 American Animal Hospital Association's Canine Vaccine Guidelines are accessible online at http://www.leerburg.com/special_report.htm .

 

The 2006 American Animal Hospital Association's Canine Vaccine Guidelines are downloadable in PDF format at http://www.aahanet.org/PublicDocumen...s06Revised.pdf .

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Following up on my own question while waiting around for Mark to reappear...

 

I read the paper Mark cited above, hoping it would shed light on his first couple of sentences above:

 

Where is the report/study that shows the results from the "titer test" being run really means the dog is protected against a viral challenge. You're assuming the test results really mean something; I'm not sure this has been proven.

But to me, it mainly addressed his third sentence:

 

Not all tests (from different manufacturers, different testing methods, or different disease) perform equally well.

 

Here is a report showing two titer tests yielding different results for the same serum samples for non-vaccinated dogs from a rabies free island. With one test none of the dogs were seropositive for rabies while the other indicated 10% of the dogs were seropositive.

However, I found another paper that, to me, shed a bit more light on the question of whether the presence of antibodies reliably equates to some level of immunity:

 

Comparative evaluation of specific ELISA and RFFIT antibody assays in the assessment of dog immunity against rabies. Epidemiology and Infection (2005), 133: 749-757

 

(Sorry if you wanted to read it and don't have full text access, but then again I'm guessing that most of you who care enough to follow the link probably do)

 

The introduction to this paper states that: "the WHO arbitrarily consider that an antibody titre of 0·5 IU/ml of sera is the threshold of seroconversion to a rabies vaccination," which I guess is what Mark is saying, that this "arbitrary" decision is based on professional judgement rather than direct evidence. Indeed, this paper makes the case that the threshold should be 1.0 IU/ml instead, because we in fact do not really know for certain what it should be, and the uncertainties (as documented in this second study) suggest that a more cautious standard be applied until we actually do the study that conclusively establishes the correct level.

 

The Ronald Schultz link that Kris provided leads to a website which says: "We have assessed duration of protective immunity primarily by two procedures; the first is held to be the "gold standard and that is to challenge the vaccinated animal with the virulent organism, the second method is to measure antibody and compare the antibody titer to that which is known to prevent infection (e.g. provide sterile immunity)." Unfortunately, there are no links to reports of the actual studies. All I was able to find as a followup was a press release on the Rabies Challenge Fund website which states: "Dr. Schultz’s serological studies documented antibody titer counts at levels known to confer immunity to rabies 7 years postvaccination."

 

Is there a published study that establishes the level that is known to confer immunity, or isn't there?

 

Kris: I think the Rabies Challenge Study is a great idea. I personally feel that there is sufficient evidence that that significant adverse reactions to vaccinations can occur (in many species), and that no organisms, human or otherwise, should be vaccinated any more often than is needed. I have a couple of minor suggestions that might help further your goal:

 

1. The Challenge Fund website has lots of information about what the Challenge Fund is, but not (that I could find) a clear statement of what is being funded, i.e. what the "Challenge" is. I suggest you add a link right at the top of the page called "About the Rabies Challenge Study" for those people who want a little more detail about what their money will go towards.

 

2. In your signature here on the BC Boards, include a hotlink to the Challenge Fund website so that people who finally decide they want to check it out after reading your nth post (n being different for each of us) can just click on the link instead of having to search for the site.

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>

 

If the vaccines provide protection, and you believe in them and take them, what are you shouldering if someone else doesn't take them? The only "at risk" individual would be the unvaccinated one...correct? That makes physiological good sense. After all, if the vaccine isn't going to protect you from the disease, why would you take it?

 

I don't think anyone disputes that there is a small risk of an adverse reaction from vaccinations generally. Those of us who vaccinate our dogs shoulder that risk because we believe the benefit outweighs it. As a result of our taking on that risk, our dogs become immune to the disease. But so long as the great majority of us are willing to do that, those who choose NOT to vaccinate also gain protection for their dogs, because our immune dogs cannot transmit the disease to them -- the population of dogs from whom the non-vaccinated dogs could contract the disease has become very, very small. So the non-vaccinating dog owners benefit from the herd immunity built up in the dog population through our efforts, without themselves sharing the risks. That is the ethical question Kim was raising, and it applies to any cooperative or community endeavor -- is it ethical to gain the benefits of others' actions without sharing the burdens of those actions?

 

Of course, if more and more people decide to avoid the risk of adverse reaction by not vaccinating, eventually herd immunity will dissipate, and nobody will get a free ride.

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I can give an example of that kind of logic.

Way back when my daughters were young they had their first set of vaccines. They both had some bad reactions from the pertussin (sp?)in it. I was very young and didn't understand the whole thing. The doctor I was with had one vaccine reaction wiht a young patient and it broke his heart. The child that had the reaction did not fare well at all. So he immediately took out the Pertussin (sp?) in our vaccines from that time forward.

Skip a few years and my oldest was going to kindergarten. She ended up getting whooping cough and almost died, had the younger one which wasn't as strong as the oldest gotten it I dare to think what might have happened.

At the time I had agreed to take that part out of the vaccine. I thought, what difference did it make, all the other kids had the shot so we'd be protected from exposure. Very had lesson learned. My last child has all his immunities up to date and I would never recommend skipping one unless the reaction was life threatening and my girls reaction was not.

 

Side note....my dh ended up with a milder version of the disease but the doc's would not diagnosis it, as that was getting the health department involved. So they treated with asthma meds and he eventually got over it. He did have all his vaccinations as a child.

 

To this day if my daughter coughs hard she gets a panicked look on her face. Very scary disease.

 

Hard lessons to learn. I don't count on anyone else's dogs being protected so I do what I think is best for my own.

 

Kristen

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Alaska,

 

If you will contact me privately, I'll e-mail you Dr. Schultz's contact information so you can call or e-mail his office and request a copy of his published work.

 

Regarding The Rabies Challenge Fund website, everyone involved with the RCF -- Dr. Dodds, Dr. Schultz, me, and our webmistress, Andrea Brinn -- is a volunteer and we shoulder our own costs for being part of this effort. While I pay for the costs associated with the website, Andrea does the graphics and maintenance. She is currently moving to another state, and like the rest of us, is juggling a busy life. Perhaps someday in the future we'll have someone dedicated full-time to maintaining the website, but we are pledged to putting all donations directly towards funding the studies with the exception of paying IRS filing fees and insurance for the trust, so we wouldn't have funds to pay for the position.

 

Anyone interested in The Rabies Challenge Fund can access it at www.RabiesChallengeFund.org.

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Eileen you are assuming that those of us who don't vaccinate for various diseases (obviously not Rabies, because of the legal requirement) are depending on herd immunity to keep our pets safe. Some may of course, but of the larger group does not. They depend more on their dogs own immune system - fed by good lifestyle, diet, etc.

 

I wouldn't want to deliberately expose my dogs to things like Parvo, but they have been. I've had vaccinated pups get sick (in particular, the first and worst case I had was a fully vaccinated 18 week old, who coincidentally crashed immunologically after her 16 week Rabies shot), and the unvaccinated and vaccinated pups and adults in the same kennel, including her two littermates, didn't miss a beat. There is more to this immunity thing than shots. Maybe one day we will have proof from science to explain that.

 

Until then...what to do eh?

 

I don't think anyone disputes that there is a small risk of an adverse reaction from vaccinations generally. Those of us who vaccinate our dogs shoulder that risk because we believe the benefit outweighs it. As a result of our taking on that risk, our dogs become immune to the disease. But so long as the great majority of us are willing to do that, those who choose NOT to vaccinate also gain protection for their dogs, because our immune dogs cannot transmit the disease to them -- the population of dogs from whom the non-vaccinated dogs could contract the disease has become very, very small. So the non-vaccinating dog owners benefit from the herd immunity built up in the dog population through our efforts, without themselves sharing the risks. That is the ethical question Kim was raising, and it applies to any cooperative or community endeavor -- is it ethical to gain the benefits of others' actions without sharing the burdens of those actions?

 

Of course, if more and more people decide to avoid the risk of adverse reaction by not vaccinating, eventually herd immunity will dissipate, and nobody will get a free ride.

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I don't think anyone disputes that there is a small risk of an adverse reaction from vaccinations generally. Those of us who vaccinate our dogs shoulder that risk because we believe the benefit outweighs it.

 

Until it is YOUR dog, it is not a SMALL risk. My veterinarian does not believe it is a small risk. - Not anymore- She cut back on vaccinations over 15 years ago, - ( not to the liking of the practice she works for, due to loss of money) but saw a huge disappearance of cancers, Auto-immune disease, skin disorders, gastrointestinal disturbances, tumor or growth appearing directly on or around the sight. - Coincidence?? - maybe, but probably not. That is why much more research is needed.

 

According to my veterinarian, vaccines are a BILLION dollar industry and vets make a large part of their income from them.

Take out 1 year of rabies vaccination and the consequential office visit-- just for dogs -- and the average small-practice vet's income drops from approximately $87,000 to $25,000 -- and this doesn't include cats or other vaccinations.

 

I'm not at all against vaccines, but the amount given through out their life span.

 

Thank-you Kris for the Rabies challenge research.

 

Kate

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I'm intrigued by Mark's skepticism about the usefulness of titer results. I too got a Hep B titer test after my Hep B vaccinations and "passed". Are you (Mark) saying that what's lacking for dog titers is a study showing what level of antibodies confers what (statistical) level of immunity, versus such studies having been done for, e.g. human Hep B? If so, do we not need such studies for common dog vaccs where adverse reactions are a concern? Or am I misunderstanding you?
Just because there is a test, for example human hep B (btw I too have had Hep titers following vaccination which is a requirement due to my potential occupational exposure) that has data showing a titer of x level means the person still has protection does not mean titer levels from ALL tests mean the living being still has protection. This must be proven for each test and each analyte via a challenge study or correlated to comparable test (one from another test manufacturer) that already has been proven by a challenge study. The literature article was to demonstrate the differences between tests in terms of results and without knowing the level that is diagnostically relevant for the exact test being run the answer is meaningless. A test for canine anti-rabies (dog antibody against rabies) is not equivalent in performance to a test for human anti-Hep B, human antibody against Hep B, or canine anti-distemper. The performance of a test from company A for canine anti-rabies is not the same as one from company B for canine anti-rabies (example: for the human cardiac marker Troponin I there are many tests which yield up to a 100x difference in value for the exact same sample Roche Diagnostics).

 

What I can gather from what I have read (I hope someone can prove me wrong) there is no one single set of data showing a wide range of titer levels followed by a viral challenge to allow us to statistically determine the titer level above which there is 100% protection against rabies and this was performed x years after vaccination (where x is 3, 5, 7, 10, or 15).

 

My skepticism stems from 14 years work experience for companies that develop, manufacture, and sell diagnostic kits (immuno-assays) and instruments. Of the tests our company has worked on, allergy tests (measuring the level of antibodies in blood/serum/plasma against other proteins) were the least accurate. One of the main problems was finding the right material to put in the test to be sensitive to the target antibody and not anything else (false positive). The best material in this case would be the live rabies virus, but this is not possible.

 

If we are going to use titers as a diagnostic for measuring protection against viruses and bacterium in place of boosters; there must be proof that measured level really means protection is still present. This is one of the reasons we need the studies the Rabies Challenge Fund is supporting.

 

Mark

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You all may find this interesting reading; I did. These are the types of studies that must be performed in order to rely upon titers as an alternative to boosters.

 

International Committee of the World Organisation for Animal Health (OIE)

During the 71st General Session of the OIE in May 2003, the International Committee adopted Resolution No. XXIX. This Resolution endorses the principle of validation and certification of diagnostic assays (test methods) for infectious animal diseases by the OIE and gives a mandate to the Director General of the OIE to set up the specific standard procedures to be used before the final decision on the validation and certification of the diagnostic assay is taken by the OIE International Committee.

 

Register of diagnostic kits certified by the OIE as validated fit for purpose(s)

 

Bio-Rad's Platelia Rabies II Validation studies Abstract Sheet

Purpose: Determination of immune status post-vaccination in individual dogs or cats (for regulation of international movement or trade), and in fox populations (for monitoring wildlife vaccination programmes).

(Please note the validation sections of this report.)

 

Bio-Rad's Platelia Rabies II User Manual

 

Mark

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More on how the various tests compare.

 

Comparison of Three Serological Tests for Titration of Rabies in Immunized Individuals

 

This study was performed on 55 vet students of whom 90.9% were males and the remaining were females. None of the three titration techniques detected anti-rabies antibodies in the pre-vaccination sera. The titer of rabies antibodies were measured after vaccination.

 

It was found that in many vaccinated students, the titer by ELISA was very low, while it was high when it was measured by other methods (MNT and RFFIT).

 

The mean±SD coefficient of variation of titers of antibody was 36.3±24.4 (67%) for MNT and 34.5±20.8 for RFFIT which were quite similar and comparable. ELISA showed lower mean of titer (14.5±13.6) and much greater coefficient of variation (94%).

These tests of immunized people yielded very wide ranging results. The 36.3±24.2 means that you can be 95% confident an immunized patient will yield a value between -11.1 and 83.7! These values do not give me confidence in the results; the poor performance could be due to the tests or the ability of the lab to run the tests.

 

Mark

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This is the procedure for running the The rapid fluorescent focus inhibition test (RFFIT); this is NOT a simple procedure it can be considered the "gold standard" rabies titer test. It does measure the amount of anti-rabies antibodies in serum samples against live rabies virus. This is not the typical "titer test"; the Bio-Rad test above would be a typical "titer test".

 

Mark

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  • 5 months later...

Arkansas Veterinary Medical Association http://www.arkvetmed.org/new.html

RABIES VACCINATIONS

New Recommendations

 

Recommendations for maintaining adequate pre-exposure immunization status: A routine booster every two years is NOT recommended since the newer cell culture vaccines often confer adequate antibody levels for 5 to 8 years and risk of adverse reactions is increased by frequent boosters. The standard pre-exposure recommendation for veterinarians practicing in an area with enzootic rabies is serologic testing every two years with booster vaccination when the antibody titer falls below the acceptable level, i.e. 1:5 by RFFIT.

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  • 3 months later...

Vaccinal adverse reactions are becoming more recognized and acknowledged in the veterinary community -- in an August 1, 2008 article in DVM360 entitled Vaccination: An Overview, http://veterinarycalendar.dvm360.com/avhc/...l.jsp?id=568351 Dr. Melissa Kennedy states that of the two types of vaccinal adverse reactions:

 

Adverse reactions have also become a major concern in small animal medicine. .... These fall into two general categories. The first is immediate hypersensitivity. This may be a local or systemic response, and is due to pre-existing antibody to the agent. This is the classic "allergic reaction" to the vaccine and can be life-threatening. The second is a delayed response, requiring days of longer to develop. The vaccine, seen as foreign, elicits a significant inflammatory response and is especially true for adjuvanted vaccines. This response can manifest as a granuloma, or more seriously, a fibrosarcoma . Further, she reports that The likelihood of adverse reactions in dogs has been found to correlate with the size of the dog and the number of inoculations given, with higher risk associated with small size and multiple inoculations.

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  • 9 months later...

Judy Schor's agility champion, Peaches, suffered a significant adverse reaction to a rabies booster. Judy has posted photos of Peaches and a letter from the vaccine manufacturer, Fort Dodge, offering a settlement to pay for medical treatment if they not disclose information about the claim. You can read the letter and see photos of Peaches at this link: http://www.facebook.com/album.php?aid=2042...5540&ref=mf .

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