Elderly animals and lowered immune system

RE: Elderly animals and lowered immune system

Andreas Ege — Mon, 10 Feb 2020 14:34:26 GMT

That's good to know, thank you.

[quote userid="4181" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28841/elderly-animals-and-lowered-immune-system/219128"]whatever the SPC states, a veterinary surgeon should take account of the recommendations and warnings on the SPC alongside any specific risk factors for the individual animal when devising the optimum vaccination schedule for the young adult.[/quote]

Would be nice if we had similar statements for other medications, as I think that's how it should be: the datasheet (SPC) as something to guide along other, often more up-to date information, and not as gospel.

Unfortunately, my impression is that regulators seem to be putting more and more blind faith in SPC's. I certainly think I normally should be able to deviate from a SPC without having to justify myself, document everything and get owners consent beyond what I normally need to treat an animal. Not the least as IMO 90+% of owners will not be able to rationally judge the risk-benefit information I give them. They either trust me, or they don't.

RE: Elderly animals and lowered immune system

Andreas Ege — Mon, 10 Feb 2020 14:28:26 GMT

[quote userid="3094" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28841/elderly-animals-and-lowered-immune-system/219119"] All being Conveniently ignored by the anti-vaccination lobby.[/quote]

Are you sure? Or do we just not hear that much about it? They certainly have an agenda with children's vaccinations. Though, to be fair, the NHS plays straight in their hands with the "information" booklets they produce.

[quote userid="3094" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28841/elderly-animals-and-lowered-immune-system/219119"] do doctors have the same discussions about such vaccines in people? [/quote]

I'd say no. If they actually see a doctor. We've never seen a doctor for vaccinations, not for us before we went to India nor the little one.

Definitely not for the off-license combination of vaccinations in babies. When the wife pointed out to the nurse, that the meningococcus B vaccine is not licensed for concurrent use with other vaccines, which does increase the risk getting fever to a degree that the NHS recommends giving paracetamol 3 times after the vaccination, she answered that she can not imagine that. Read the f... leaflet, was my only thought.

I'm still not getting over it, that my cat is better protected than my Baby.

RE: Elderly animals and lowered immune system

Anthony Dennison — Mon, 10 Feb 2020 13:57:38 GMT

[quote userid="3094" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28841/elderly-animals-and-lowered-immune-system/219119"]Is it significant that humans over 60years hve the inflienza vaccine every year?[/quote]

Think this is because the strains in the 'flu vaccine change every year rather than immunity only lasting 12 months

RE: Elderly animals and lowered immune system

Rob Loxley — Thu, 30 Jan 2020 18:33:08 GMT

[quote userid="13609" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28841/elderly-animals-and-lowered-immune-system/219111"]Strictly speaking, the first re-vaccination with everything, would be off-label use again... ;-)[/quote]

As you're mopping up the non-responders from the 1st 2 vaccine doses (which the datasheet ignores the existence of!), maybe this next vaccine should be at 6 months, or maybe 16 weeks?

PS there is a VMD paper (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/769590/_281595-v6-VMD_Position_paper_on_Authorised_Vaccination_Scedules_for_Dogs.pdf) which addresses some of the conflicts between SPC ('datasheet') and WSAVA guidelines, from which I have cherry picked:

whatever the SPC states, a veterinary surgeon should take account of the recommendations and warnings on the SPC alongside any specific risk factors for the individual animal when devising the optimum vaccination schedule for the young adult. This may follow either the recommendation for a first full yearly booster, as may be specified in the SPC of some products and WSAVA Guidelines, or this may prove to be unnecessary

and

A veterinary surgeon is empowered to make a clinical benefit/risk judgement based on the local reports of infection and taking account of the age, health, home environment, travel plans and lifestyle for each individual animal presented for vaccination and discuss recommended vaccine schedules with the owner. Thus the decision to vaccinate the individual patient and the frequency thereof is a matter for the veterinary surgeon and his client to discuss. It is not an issue where the VMD should intervene

RE: Elderly animals and lowered immune system

Julian Earl — Thu, 30 Jan 2020 14:17:13 GMT

Is it significant that humans over 60years hve the inflienza vaccine every year? Rabies vaccine every 3 years IIRC..Tetanus every, what, 5 years? All being Conveniently ignored by the anti-vaccination lobby. With 'flu, one can argue that the serotype canges a lot but even so, do doctors have the same discussions about such vaccines in people?

RE: Elderly animals and lowered immune system

Andreas Ege — Thu, 30 Jan 2020 11:06:24 GMT

[quote userid="20641" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28841/elderly-animals-and-lowered-immune-system/219097"]but until then we must follow the manufacturer’s licence unless we have good reason to go ‘off-label’. [/quote]

If recommendations like the WSAVA vaccination guidelines, which, I expect, are based on scientific evidence, are not good enough reason to go "off-label", then we can as well hand over our therapeutic freedom to the pharmaceutical companies and let them take full control of our decision tree.

It really keeps p...ing me off, that licensing politics and leaflet information that often has not been changed or updated in years, gets treated like gospel.

Pharmaceutical companies use this devotion to their holy words as a weapon to increase revenue and frequently against the benefit of patients and vets. Regulators have completely failed, unless their job is to improve the situation for pharmaceutical companies. Why is Alizin not licensed to treat pyometra? It gets used anyway, why should the manufacturer spend money on the licensing aspect.

Rant off, though I could go on a lot longer.

Bottom line, I'd rather base my decisions on (hopefully impartial) scientific evidence, expert opinion and personal experience than on a leaflet primarily produced to comply to economic interests, business politics and regulators expectatioms.

NB: feline panleukopenia (at least nobivac) is licensed for 3 yearly as well. I guess, strictly speaking, any practice/ vet using these vaccines on a more frequent basis would need to have the owners sign a form of consent for off-label use.

There's nothing of the "and plus one month" in the leaflets.

At least for DHP and feline P the 3 yearly interval according to leaflet is straight after the primary course. Strictly speaking, the first re-vaccination with everything, would be off-label use again... ;-)

RE: Elderly animals and lowered immune system

Rob Loxley — Thu, 30 Jan 2020 08:47:27 GMT

[quote userid="20641" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28841/elderly-animals-and-lowered-immune-system/219097"]We use MSD Nobivac vaccines and MSD only guarantees protection (therefore protection for us vets as well when things go wrong) within a year and plus one month for most vaccines...[/quote]

Do you have a reference for this?
And Nobivac DHP, rabies and FeLV are every 3 years once primary and 1st revacc done

RE: Elderly animals and lowered immune system

Imre Pesta — Thu, 30 Jan 2020 07:43:26 GMT

In theory you might be right (was there any study comparing different bands?) and titer testing is the future like in hand, but until then we must follow the manufacturer’s licence unless we have good reason to go ‘off-label’. We use MSD Nobivac vaccines and MSD only guarantees protection (therefore protection for us vets as well when things go wrong) within a year and plus one month for most vaccines...

RE: Elderly animals and lowered immune system

Andreas Ege — Wed, 29 Jan 2020 13:17:31 GMT

[quote userid="2675" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28841/elderly-animals-and-lowered-immune-system/219073"] trial had been done in USA with repeated injections every 2 weeks and within a very short period (couple of months), renal damage/degeneration could be demonstrated[/quote]

From the bits above there can be only one certain conclusion: vaccinating cats every 2 weeks is not a good idea. Thank god nobody but some researchers are doing it. I honestly can't see, what the purpose of this study would have been. Which, imo, makes it ethically questionable. It certainly would not be suitable to draw any reliable conclusions about risks from "normal" vaccination protocols.

Maybe they where thinking they simulate a lifetime of vaccinations within a few months, it's obviously not that simple.

But obviously, that's all just speculation on my end.

RE: Elderly animals and lowered immune system

Lindsey Edwards — Wed, 29 Jan 2020 12:59:24 GMT

Not sure if repeated vaccines every 2 weeks can be used as a direct model compared to 'regular' vaccine schedules. I'm not convinced annual vaccination is required for all diseases and species either. Particularly in cats I think we vaccinate too few cats too often but it is unlikely any degree of herd immunity will ever be achieved given the number of semi-ferals and 'strays'

RE: Elderly animals and lowered immune system

Richard Carter — Wed, 29 Jan 2020 12:21:27 GMT

There was a paper in preparation mentioned at ISFM congress last year (Prof Mike Lappin) where a trial had been done in USA with repeated injections every 2 weeks and within a very short period (couple of months), renal damage/degeneration could be demonstrated but don't know if been published yet so assumed this reference was building on that work.

RE: Elderly animals and lowered immune system

Andreas Ege — Wed, 29 Jan 2020 09:53:22 GMT

[quote userid="2675" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28841/elderly-animals-and-lowered-immune-system"]Following on from a webinar last night where the advice was to annually vaccinate elderly cats on the basis on 'lower immune system' - is this a fact [/quote]

Very good question I would be interested to learn the answer as well. My wife sometimes runs titre clinics for clients that rather test than vaccinate (the WSAVA actually does recommend this for DHP as being more evidence based than yearly vaccinations ) and the recommendation there is the same, to test the animals yearly when they are older.

I can't remember the WSAVA recommendations having a different approach for elderly animals, so my hunch would be, that it is just a suspicion. Then again, in humans they assume the same thing.

The other question would be, where is the cut-off age. 8 years? 12 years?

[quote userid="2675" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28841/elderly-animals-and-lowered-immune-system"]And apparently vaccination is definitely linked to kidney disease so the central message was - vaccinate more cats but each cat less often[/quote]

How definit is that link, really? I know only about studies finding that cats do develop antibodies against renal proteins from some vaccines but they couldn't show a link to kidney disease. One more recent study did find a statistical link between anual vaccinations and kidney disease (but also, for example, between dental disease and kidney disease).

That does suggest there might be a link, but in the end, statistical correlation does not equal causation. From all the evidence I can see, I'd rather say vaccinations are tentatively linked to kidney disease, but certainly not "definitely".