Evidence for annual vaccination?

Re: Evidence for annual vaccination?

grumpyoldman — Wed, 26 Feb 2014 20:44:53 GMT

JSAP MAY 2010, I think , core vaccine interval of 3 years after first course and first booster ,lepto only significant in endemic areas and if it really is a problem should be every 6 months.

This will also keep the corporate shite out of your database ,you cannot sell people cheap vaccines they do not actually need to get them in the door .

Re: Evidence for annual vaccination?

Colin Cameron — Tue, 17 Aug 2010 13:56:53 GMT

[quote user="Hannah Wynne Richards"]

I give a second lepto if they are 3 months overdue-reasons as stated b4

[/quote]

What are "ovedue-reasons"? I assume b4 means before ( I don't speak Mobile text) ( see other fun posting "Adjectives used as nouns"). Seriously though, the last time we enquired about this were advised by the manufacturer to allow up to 18 months before we would have to repeat the primary leptospirosis vaccination .

Re: Evidence for annual vaccination?

Hannah Wynne Richards — Mon, 05 Oct 2009 17:50:49 GMT

I give a second lepto if they are 3 months overdue-reasons as stated b4

Wynne

Re: Evidence for annual vaccination?

HERETIC — Mon, 28 Sep 2009 20:48:17 GMT

Can I add another line on this. At what point do most people insist on restarting a course following an overdue booster? I have come accross practices which "start again "after only a month overdue. Many years ago an immunologist told me that the cell mediated anamnistic response lasted many years,possibly lifelong,after the primary course.Is the double dose just a money spinner? Is there any real evidence about this at all?I dont want to over vaccinate or leave my patients underprotected.

Re: Evidence for annual vaccination?

Alex Gough — Mon, 29 Jun 2009 18:33:25 GMT

Art you havent answered any questions, even when I PICOd them for you. I must admit I feel like you have played some sort of trick on me, getting me to rephrase my questions in a way you say is the only way you will answer them, and then not answering anyway. For this reason I see no point in continuing this debate with you at all.

alex

Re: Evidence for annual vaccination?

The SkepVet — Mon, 29 Jun 2009 14:54:02 GMT

Guys, I have posted on the sciencebasedmedicine.org thread about pet vaccination. Rather than contiue to debate with Arlo and Alex if I have aswered questions to everyone satisfaction why not take this debate outside in the open somewhere where like the oldest pet forum aol vet-vet?

http://messageboards.aol.com/aol/en_us/articles.php?boardId=216324&func=3&channel=Find+a+Job&refresh=true

Vets and Vet forum editors can even post on the aol vet-vet forum without giving your name.

Art Malernee dvm

The SkepVet

Re: Evidence for annual vaccination?

Alex Gough — Sun, 28 Jun 2009 19:21:52 GMT

That would be pretty subtle!

Alex

Re: Evidence for annual vaccination?

Alex Gough — Sun, 28 Jun 2009 19:21:14 GMT

Because I would assume that the client would have less knowledge than me on the subject, and is more likely to come to me and ask what I would recommend vaccinatiing against. if they came to me for a vaccine and i said why do you want to vaccinate your dog, they would look at me like I was an idiot, and would rightly expect me to provide the answer, not them.

As for using a medicine that can be shown to work, lepto vaccines have been proven by challenge trials, so no worries for me there.

You still havent answered the PICO questions I gave you, despite my going to some effort to formulate the question in a way you said you would answer.

Of as much interest to me is your answer to the following, which i will see if I can put in a PICO form.

Problem: Art implies that vets who recommend annual lepto vaccination should be struck off.

Intervention: Removing name from the register.

Comparison: Is it an effective method of regulating medicine to strike off vets who follow data sheet recommendations and expert guidelines on the use of vaccines, compared with not striking them off.

Outcome: Does striking vets off for recommending annual lepto vaccination improve the healthcare of pets?

alex

Re: Evidence for annual vaccination?

Niall Taylor — Sun, 28 Jun 2009 18:12:08 GMT

[quote user="alex gough"]This is a joke.[/quote]

True synchronicity - I believe we have finally arrived at the revelation to which Art, with all the subtlety of a Zen master, has been guiding us.

Cheers,

Niall

Re: Evidence for annual vaccination?

The SkepVet — Sun, 28 Jun 2009 17:35:51 GMT

If we go down that route, we will end up with a client coming into the consulting room, and asking "should I vaccinate my dog against Lepto," and we would just have to say - I dont know, >>>>

Why not ask the client why they want to vaccinate their dog against lepto and then offer them medicine that can be shown to work. Demonstrating the mechanism isn't necessary, but demonstrating the effect IS

art malernee dvm

Re: Evidence for annual vaccination?

Alex Gough — Sun, 28 Jun 2009 15:49:23 GMT

oh sorry, I meant the ABCD thing was a joke. the rest isnt.

alex

Re: Evidence for annual vaccination?

Alex Gough — Sun, 28 Jun 2009 15:48:52 GMT

[quote user="The SkepVet"]Now I am confused unless alex and arlo are just playing a joke on me.[/quote]

This is a joke.

[quote user="The SkepVet"]but if there are no answers in existence, what is the point of asking the questions?>>>>[/quote]

This isn't.

My point Art, is that we have a limited amount of data, and it may not be as comprehensive or high quality as we like, but it is the best we have. There is no point refusing to answer a question because the data we have doesnt allow us to answer the question we would prefer to ask. If we go down that route, we will end up with a client coming into the consulting room, and asking "should I vaccinate my dog against Lepto," and we would just have to say - I dont know, the studies arent high quality enough so your guess is as good as mine. Maybe that is how you feel, but if we took that approach to the whole of veterinary medicine, or indeed human medicine, precious little would be done at all. [BTW - if a client asks you a clinical question such as that, do you tell them to PICO it before you are prepared to answer?]

Let me take a completely hypothetical and made up example. I'm going to pretend there is a rare disease called immune-mediated brain combustion (IMBC). There are two hypothetical papers. One case series shows that of 20 dogs diagnosed at high risk of the disease, (they were observed to have smoke coming out of their ears) 15 brains combusted in the following 12 months.

In a second case series, of 20 dogs at high risk that were treated with high dose steroids, only 11 combusted in the following 12 months. Both studies were retrospective and uncontrolled. That is the full extent of the information we have on the disease.

My question, then is - should we treat this diseaes. To PICO it in fact

P - IMBC

I- high dose steroids

C - use of steroids compared to no treatment

O - prevention of brain combustion.

Do we use high dose steroids, which have potentially serious side effects, in the face of weak evidence like this? We are actually faced with this conundrum all the time, because there is so little high quality evidence out there for so many things, especially less common conditions.

I hope you can see the relevance to the way you are posing clinical questions and discussing treatment. You are asking us to only base our decisions on high quality data - yet often that data doesnt exist. Do we then just ignore the problem?

Most texts and references to evidence based medicine quote the pyramid of evidence - that we should practice on the best possible evidence available. If that is a meta analysis great. If the disease is so rare there are are only 3 case reports, and 2 of them responded to a particular intervention, that probably means going with that intervention.

Alex

Re: Evidence for annual vaccination?

The SkepVet — Sun, 28 Jun 2009 14:27:48 GMT

2. I try to get arlo to clarfiy and pico the question so I can try and see if there is a answer it because you can not aswer does god exhist type of clinical question>>>

Sorry, that sentence should read

2. I try to get arlo to clarfiy and pico the question so I can try and see if there is a answer to it because you can not aswer does god exhist type of clinical question

I hope "to" should not have been spelled two or too. The kings english always confuses me. Why not use a real language where if you can talk it you can write it?

art malernee dvm

Re: Evidence for annual vaccination?

The SkepVet — Sun, 28 Jun 2009 14:02:43 GMT

but if there are no answers in existence, what is the point of asking the questions?>>>>

Now I am confused unless alex and arlo are just playing a joke on me.

1. arlo ask me a clincal question

2. I try to get arlo to clarfiy and pico the question so I can try and see if there is a answer it because you can not aswer does god exhist type of clinical question

3. I am told because I do will not answer alex questions I may be toast.

Can everyone see now why doctors that post on the list should not be required to answer "Does God Exhist" questions unless they can be PICOed. Clinical questions and answers in medicine must measure something. Or another way to put it is clinical guides and laws must be based on studys where randomized trials have shown to help. Otherwise all you end up with are the type of people who contol the medical professions by treating ear infections with serial joint manipulation.

art malernee dvm

Re: Evidence for annual vaccination?

Alex Gough — Sat, 27 Jun 2009 17:41:21 GMT

Well those are interesting questions Art, but if there are no answers in existence, what is the point of asking the questions? I could ask you to target the question to client owned dogs in the south west, as this would be most relevance to me, but I know there aren't any studies answering that question. Why not just analyse the evidence that actually does exist?

In future, could you ask any questions of me according to the ABCD guidelines, which dictate that the words in any question you ask must be in alphabetical order?

alex

Re: Evidence for annual vaccination?

The SkepVet — Sat, 27 Jun 2009 13:01:56 GMT

First stage in the growth of the community is me talking to myself. That's quite dull. And a bit nerve-wracking when you've blown as much money as I have on this! >>>>

Arlo, What can I do to help you make money? I am trying to be as scientific and humorous at the same time as I can be. Maybe those who preach evidence based medicine should have their own place to go on this forum so doctors can find out whats been proven to work.

art malernee dvm

Re: Evidence for annual vaccination?

The SkepVet — Sat, 27 Jun 2009 12:36:22 GMT

How is it best prevented?>>>>>> Alex, what are we going to measure to try and answer the question? To answer the question we must measure something. We also need a target population. Do you want the question to be about a population in the UK or could the target populations be other places? Do you want to limit the target population to dogs? Dogs in a lab or dogs owned or stray dogs?

Art Malernee dvm

Re: Evidence for annual vaccination?

Arlo Guthrie — Sat, 27 Jun 2009 07:37:15 GMT

[quote user="Stephen Ashman"] Put it in the contro box, it's all gone a bit quiet down there, could do with a boost![/quote]

Good idea.

But just noticed that the thread hasn't come out of the main listings, as it should when I put it here. Will have to speak with the techie on Monday.

Re: Evidence for annual vaccination?

Alex Gough — Fri, 26 Jun 2009 21:31:06 GMT

The PICO stuff is interesting Art, but as you noted this is an informal forum, and refusing to answer questions because they arent structured the way you wish them to be is just obstructive. Still - will have a quick go at playing ball, just because of my perverse desire to get you to answer a question.

Problem - leptospira is a zoonotic, endemic disease, which is common in the UK and is often fatal. How is it best prevented?

intervention - vaccination

Comparison - is it better to vaccinate against leptospira annually, or less frequently, or not at all?ie how does annual vaccination with leptospira vaccine compare in ability to prevent leptospira in comparison to vaccinating less frequently or not at all?

Outcome - which of the above protocols best prevents the disease?

Alex

Re: Evidence for annual vaccination?

Stephen Ashman — Fri, 26 Jun 2009 20:03:26 GMT

[quote user="Arlo Guthrie"]This could get interesting[/quote]

Put it in the contro box, it's all gone a bit quiet down there, could do with a boost!

Re: Evidence for annual vaccination?

Arlo Guthrie — Fri, 26 Jun 2009 18:47:22 GMT

[quote user="Graham Bilbrough"] Arlo, do you ever get this much "grief" on the VetNurse site?[/quote]

Nope

But I see it as a positive thing (no, really).

First stage in the growth of the community is me talking to myself. That's quite dull. And a bit nerve-wracking when you've blown as much money as I have on this!

Second stage is members talking to each other and with me. At this point membership is growing and inevitably there will be some newcomers who have an agenda, or want to stir things up, or who post nonsense. My job to try and steer things (both as moderator and technologically) so that extreme elements don't overpower the whole thing, and deter the quiet majority from using the forum for its intended purpose. Inevitably, I will be shot down in flames a few times in the process.

Then the community becomes self-policing (as it is to a large degree on VetNurse), and my role becomes less important, if not redundant.

I'm delighted to be taking some flack. It means we're making some progress. I just hope that I do my job right, and in a few months time we reach a state of happy equilibrium.

Re: Evidence for annual vaccination?

Ian Mostyn — Fri, 26 Jun 2009 18:32:42 GMT

"Does God Exist" complies with two general rules that should apply to all questions:

Keep it short and keep it simple. I also suspect that their is much more grief with the nurses judging from some posts on there (but probably more praise). :)

Ian

Re: Evidence for annual vaccination?

Graham Bilbrough — Fri, 26 Jun 2009 18:09:36 GMT

Arlo, do you ever get this much "grief" on the VetNurse site?

Re: Evidence for annual vaccination?

Arlo Guthrie — Fri, 26 Jun 2009 16:23:57 GMT

This could get interesting. Anyone following this: Art just gave himself five stars for what he considered to be his own 'excellent post' and me 1 star for my 'poor' post.

Thankfully, democracy is at work, and I returned fire giving him 1 for his post, and a blistering 5 for my own eloquent, insightful and sparklingly witty offering.

The system counts the votes and displays the average. So now, at the time of writing, we both stand at 3 stars each. If anyone else would care to vote, it will adjust our posts accordingly.

[quote user="The SkepVet"]Arlo, not sure about what I think about a ratings system.[/quote]

That doesn't altogether surprise me.

[quote user="The SkepVet"]If you continue to get poor star ratings will you suspend your ablity to post in this forum [/quote]

Clearly not. That's the thing about a dictatorship, albeit a benign one.

Seriously, whilst I'm obviously not going to suspend myself, if I get poor votes, I'll certainly try and use the feedback constructively.

Re: Evidence for annual vaccination?

The SkepVet — Fri, 26 Jun 2009 15:40:34 GMT

In case the computer edits my five star rating post and Arlos one star rating post here it is again

replied on

Friday, 26 Jun 2009 at 15:32

rate this post

>>>>> A poor rating helps the author understand they need to raise their game a bit.

I may suspend their ability to post in the forum.>>>>

>>>>Friday, 26 Jun 2009 at 15:10

rate this post

Crikey, here we go again

I was actually half-way through writing 'off-topic' this morning when I got diverted with something else. And now war has broken out again.

Once again, I'm going to turn to technology to try and solve this problem.

First of all, I am extremely keen NOT to frighten anyone away from this forum because English is not their first language. Usually, it is fairly obvious that is the case, and we all can and do make allowances for that.

I also agree with Art that criticising minor errors (speling mistackes and minor grammatical errors), outside of a need to clarify, is unbecoming.

But where does one draw the line? Repeatedly posting stuff which is riddled with typos and contains incorrectly constructed sentences is arguably lazy and somewhat disrespectful of the readers.

The answer I think lies with technology. Above each post, you'll see a number of stars to rate each post. EVERYONE PLEASE USE THEM. Your vote is anonymous.

The rating system helps both the author of the post, and me. A poor rating helps the author understand they need to raise their game a bit. And if someone is getting consistently poor ratings, I may suspend their ability to post in the forum.

We are right now working on upgrading the star rating system. First, to colour code it. Second so that perhaps, if a post has too many poor ratings, it will be hidden from immediate view (it will still be able to be revealed if you wish).

If you use ratings instead of commenting on people's grammar, it also makes it a little less personal.>>>>>

Arlo, not sure about what I think about a ratings system. If you continue to get poor star ratings will you suspend your ablity to post in this forum or does this only apply to the vets who compete with each other in business?

art malernee dvm