Lepto4 Vaccine

RE: Lepto4 Vaccine

Martin Atkinson — Wed, 08 Feb 2017 17:08:10 GMT

Don't forget folks when you change away from Versican that it contains a CPV2b vaccine component that none of the other brands do. This is to me far more important than arguments over L2/L4. Your vaccine company may tell you that the old CPV2 and 2a vaccines cover 2b, if you look a little below the surface you may be surprised with what you find and what they are not telling you. I've beaten this drum for long enough but there seems to be collective ostrich like behaviour.

RE: Lepto4 Vaccine

Rob Davis — Tue, 07 Feb 2017 19:57:49 GMT

Thanks for that, Mariette, very interesting.

[quote user="mariette asselbergs"]For Europe, vaccination recommendations are straight forward: since leptospirosis cases have been found widespread in dogs vaccinated with the bi-valent vaccine, vaccination with the quadrivalent vaccines are recommended.[/quote]

I assume this is talking about continental Europe as I'm not aware of widespread lepto in dogs vaccinated with bivalent vaccine in the UK (I would be very interested to know if any one else's experience differs from this). Are there many cases of quadrivalent vaccination failures? Has the introduction of quadrivalent vaccines reduced clinical cases?

RE: Lepto4 Vaccine

mariette asselbergs — Tue, 07 Feb 2017 19:49:16 GMT

As for vaccination reactions: as others have said: bad reactions to versican, much better with nobivac. Seen nasty and painful lumps progressing to embarrassing abscesses. Embarrassing in small puppies! And in adults who never had a vacc reaction! But I still vaccinated my dog who loves to swim, and guess what: no reaction whatsoever (with the same versican)....

Mariette

RE: Lepto4 Vaccine

mariette asselbergs — Tue, 07 Feb 2017 19:46:24 GMT

[quote user="Richard Carter"]

we also sticking to lepto 2 - no indication yet for us to switch and the lepto 4 has been a bit of a craze thing - my dog has more leptos than yours!

Also the data sheet for Lepto 4 states the second vaccination has to be done 4 weeks apart - the usual flexible 2-4 weeks we have on our current vaccines would then be legally 'invalid' if we used the Lepto 4. Do you think a vaccine in the morning followed by a vaccine in the evening making 680 hours instead of 672 hours apart would make the course invalid??

Just wondering how far up our own rear ends we are becoming over this vaccine thing with petty 'sticking to the data sheet we have to restart Fido's whole course now because you are 2 days late' and hoping it doesn't come back to bite us as a profession big time if/when someone finally does long term immunity challenge trials

[/quote]

Here is some evidence:

(I meant to add a file but that doesn't seem possible, so apologies for a very long post)

S Schuller et al (2015), European consensus statement on leptospirosis in dogs and cats, Journal of Small Animal Practice, 56, 159-179, DOI: 10.1111/jsap.12328.

Critical review, Mariette Asselbergs April 2015 (for BSAVA Cert ECC course)

This is a consensus review on best evidence compiled and assessed by a panel of experts (two from the USA, three from Europe) called upon by the International Society of Companion Animal Infectious Diseases (ISCAID) in 2012 and meant for veterinary practitioners.

It presents the evidence over a period from 1933 when non-Weil leptospirosis was first reported by Klarenbeek in the Netherlands up to publications dated 2013, although the majority of quoted literature is from the last 25 years.

It compiles evidence from single cases (one dog still shedding leptospiras in its urine despite 10 day treatment with penicillin and doxycyclin) to 389 cases from 12 different publications reporting clinical symptoms, and 410 cases in 13 publications reporting haematological and biochemistry altercations in leptospirosis.

As a start an attempt is made to clarify the present situation with regard to Leptospirosis species (based on modern DNA hybridization), which does not completely agree/overlap with the older classification in serovar groups (e.g. icterohaemorrhagica, canicola, grippotyphosa) which are based on agglutination with patient antisera, and specific serovars based on reaction with specific monoclonal antisera. Then there are still distinct strains in serovars, based on specific isolates.

An overview is given of the role of the various serogroups in the epidemiology, especially the geographic distribution and the main reservoir hosts for the different serovar (groups).

In the epidemiology a number of hosts are considered, but rodents are considered the most important. The environment is a second determining influence with leptospirosis both in animals and humans being a seasonal disease related to rainfall and ambient temperatures. But an attempt to analyse specific risk factors in dogs failed to identify them and the panel thus recommends to ignore a dogs signalment, (including lifestyle) when considering leptospirosis in a differential diagnosis

In cats, being hunters of rodents, it is not surprising that antobody evidence has been found of up to 48% as well as evidence that cats can shed leptospiras in their urine, but clinical disease is considered rare.

Since it is difficult to diagnoses specific serovars, in further discussions on pathogenesis, clinical symptoms and treatment not much further attempt is made to link these with different serogroups, serovars or strains. This may explain a broad spectrum of clinical symptoms possible. Generally leptospirosis is a disease with a relatively symptomless first haematological phase, undetected by the immunological system, then cleared from the blood and persisting in multiple organs with kidneys, liver and lungs being most frequently affected, but other organs including the eyes possible targets too. Classically symptoms were predominantly related to kidney and liver damage, first acute, later followed by chronic sequellae. This included clotting disorders and bleeding. The last few years a specific syndrome Leptospirosis Pulmonary Haemorrhagic Syndrome (LPHS) has been diagnosed more frequently in both dogs and other species including humans, mostly in Europe. It is not clear if this is linked to a shift in serovars. Other less common symptoms include pancreatitis, intestinal intussusception, myocarditis and ophthalmic symptoms including uveitis specially in horses and humans, and other more varied ophthalmic symptoms in dogs. Severe systemic and/or skin calcification have also been seen.

Blood and urine changes are the ones expected with acute renal failure and hepatic damage, with isosthenuria in combination with non-diabetic glucosuria being particularly suspicious of leptospirosis.

Diagnostic imaging in cases suspect of LPHS show bilateral dorsocaudal radiographic changes, from mild to severe, but these may underestimate the actual damage. Abdominal ultrasound is expected to show cortical hyperechogenicity with a medullary band of hyperechogenecity and possible general organomegaly.

As for testing, the Microscopic Agglutination Test (MAT) based on agglutination of a number of appropriate live leptispira serovars by patient's serum antibodies is still considered the gold standard if done in pairs 1-2 weeks apart. In the acute phase of the disease, antibodies might still be lacking or low, but in vaccinated dogs there might be antibodies left even after more than 15 weeks post vaccination. In clinical cases titres in paired samples are expected to increase fourfold or more. However, it is important that the proper local serovars are included for the test to be trustworthy. On the other hand, cross agglutination reactions preclude the use of the MAT to identify serovars involved.

More recently developed ELISA tests measuring canine IgG against leptispira serovars, and PCR targeting the LipI.32/hap 1 gene, specific for pathogenic Leptospira spp. have become available, but the panel still recommends to use them in combination with the MAT and clinical history. The PCR can be done on blood and urine. The advantage is that this test is not affected by vaccination status, however a negative test may be the result of antibiotic treatment, so samples must be taker before this treatment. In untreated animals, the PCR on urine may be used to detect carriers.

The mainstay of treatment is antibiotic treatment and supportive treatment focused on the clinical symptoms. Because of the normal gastrointestinal upset, treatment is recommended to start with parenteral penicillins, followed by oral doxycycline of sufficient duration (2 weeks minimum) to result in renal clearance. Treatment intervals should take into account (failure of) renal functioning.

Acute renal failure is treated in the usual way, but the panel agrees that Renal Replacement Therapy (dialysis) is often successful to give kidneys time to recover. In cases of LPHS the use of immunomodulating treatment in combination with the usual supportive therapy is considered to still be in a preliminary stage to be recommended widely.

Doxycycline for 2 weeks is also recommended for dogs in the same household as prophylaxis.

Since Chronic Renal Failure (CRF) is a recognised later consequence of having survived leptospirosis, follow up with monitoring of kidney function is recommended in recovered cases.

For Europe, vaccination recommendations are straight forward: since leptospirosis cases have been found widespread in dogs vaccinated with the bi-valent vaccine, vaccination with the quadrivalent vaccines are recommended. The panel is less certain about the place of leptospirosis vaccination in the core vaccinations. All dogs “at risk” should be vaccinated. But as mentioned earlier there is no clear association of “risks” from signalment or lifestyle with infection. Basic vaccination includes two applications three to four weeks apart, with a booster every 12 months and a restart if more than 18 months have been passed. The panel also recommends to vaccinate in spring, to cover the seasonality of the disease. Anaphylactic reactions are no longer considered to be a matter of concern, even in small dogs.

The discussion of Leptospirosis in cats is only a small part of the review, reflecting the lack of data. Main concerns are about the possible role of undiagnosed leptospirosis in cats in the development of CKF, and the potential reservoir role of cats in shedding leptospira in their urine.

One of the main objectives of the review was to raise awareness of leptospirosis as a potentially zoonotic risk. In humans the disease is often mild, but sometimes serious up to fatal. Both cats and dogs can shed leptospira in urine, even while not showing symptoms. Although this may be a hazard to people, the panel quotes just one study of veterinary staff in a hospital with a “high” case load, and pet owners of infected dogs, and found seropositivity in this group “uncommon”.

The panel recommends to take appropriate precautions when handling suspicious cases (hand washing, use of household disinfectants), to treat confirmed cases with appropriate length of time with doxycycline, as well as in contact dogs, and to seek medical help as soon as feeling unwell. It also suggests to use the PCR urine test to check for continuous shedding.

I found this an excellent overview of the present state of knowledge about leptospirosis. It is also a nice illustration of how EBVM is (supposed to be) used. “Evidence” is one thing, it still needs to be assessed, how good is it, is it all there is? A panel of experts may come to different conclusions from the one vet trying to find the best evidence!

However I have a few question marks. The Panel states right at the beginning that their objective is to raise awareness of leptospirosis. In the process of raising awareness however, I find some statements lacking convincing evidence.

Leptospirosis is called a “common disease”. But no figures are given to define what is meant by “common”. I have been a vet for 40 years, and have only seen a handful of cases, some as a student in my University hospital, two cases in small animal practice in the last 3 years working in a large practice (18 vets). Do we underdiagnose that much, maybe we do?

Also much is made of Leptospirosis being a zoonotic disease and cats and dogs being able to shed leptospira in their urine and becoming potential sources of infection for humans. But in the one study quoted trying to find evidence of animal-human transmission, this evidence is cited as “uncommon”. Without data to show the extend of actual transmission of leptospirosis to humans, the risk sounds more potential than real.

We may well compare this to the risk of rabies in the UK (Lyssa virus present in bats actually responsible for at least 2 human deaths), bovine TB in cattle, alpacas, sheep, wildlife and cats, but very understated as a risk for humans since the pasteurisation of milk. No special measures to protect or even monitor farmers and their families (often drinking unpasteurised milk) and veterinary TB testers, all subject to snorting cows spraying potentially infected material around. Campylobacter contamination of chickens, another zoonotic hazard, is accepted because considered unavoidable in modern industrial poultry rearing and processing.

I also found the presentation of clinical and haematological/biochemistry symptoms, collated from a dozen of studies, and presented as the spectrum of presentations for “Leptospirosis” in dogs both useful and a bit frustrating, especially in the light of the multitude of pathogenic serovars (and saprophytic ones) identified. It gives the spectrum of all possible presentations, but I would have expected more emphasis on the fact that we are talking about a disease caused by many different serovars. The geographical distribution of LPHS for example suggests a link to certain serovars or strains. Similarly no discussion is dedicated to the choice of certain serovars for vaccination purposes. I suppose this reflects the difficulty of diagnosing specific serovars and linking them to specific presentations until now.

I was personally a bit puzzled by the first line treatment of gram negative bacteria with the penicilline group. The more so, since as a large animal vet in Mozambique we regularly dealt with Leptospira abortion storms in pigs, where the treatment used to be injecting all female pigs with Streptomycin according to the Merck Veterinary Manual. Streptomycin is mentioned as the 3^rd choice after penicilline and doxycyclin treatment failed to clear one dog of shedding. I do appreciate that Streptomycin has its own disadvantages and side-effects in dogs!

Altogether the review shows lots of interesting topics for future research: The role of rodent leptospirosis in CKF in cats, the protecting role of quadrivalent vaccine against specific pathogenic serovars, the need for quadrivalent vaccine in the UK, the interesting recommendation to vaccinate dogs against leptospirosis in spring.

Mariette

RE: Lepto4 Vaccine

Ashlea — Tue, 07 Feb 2017 09:14:14 GMT

We've been using Nobivac L4 for nearly 2 years now and I can't remember any adverse reactions. I haven't noticed any increased pain compared to the L2 - I do make sure the L4 is warmed and certainly for puppies do the 25G needle and lots of treats thing. I always try to remember to give advance warning that the vaccine might sting after, especially in the more 'sensitive' breeds. I tend to ask at second vaccine whether the puppy was off-colour after the first vaccine and haven't heard anything more than them being a bit quiet for a few hours after. I'm also noticing a lot more puppies coming in already chipped, which always makes me happy as I hate microchipping at first vaccine!

RE: Lepto4 Vaccine

Duncan Reavell — Mon, 06 Feb 2017 17:41:32 GMT

My practice used Versican for about 3 months a year ago, then we became concerned with the number of reactions (mostly lumps and soreness as spelled out in the data sheet) so switched to Nobivac L4. Since then we have been monitoring reactions very closely and feel the rate of any problems is much lower and we are very happy.

As a consequence I was surprised to hear the Telegraph and Mail were referring to Nobivac rather than Versican!

RE: Lepto4 Vaccine

mjoyce — Mon, 06 Feb 2017 10:36:14 GMT

No you are right . Definitely more are already chipped when first presented

RE: Lepto4 Vaccine

Sarah Keir — Mon, 06 Feb 2017 10:36:06 GMT

Almost all the puppies I see are not microchipped when I see them at 8-10 weeks.

RE: Lepto4 Vaccine

Nicola Lawlor — Mon, 06 Feb 2017 07:43:24 GMT

[quote user="mjoyce"]Agreed . Vivitreat broken up and wait till they are really chewing it before vacc. Also tend to wait till 2nd vacc before id chipping. Hopefully this may help in not immediately starting off with fearful association of vet table [/quote]

Are people really seeing this many puppies without microchips already placed at first vaccine? We get an occasional one still but a very high % are coming already chipped as per the law introduced last year.

RE: Lepto4 Vaccine

mjoyce — Sun, 05 Feb 2017 10:20:31 GMT

[quote user="Robin Grimmer"]

[quote user="Emily Rainbow"]

I always try and tempt with biscuits whilst giving vacc and also use an orange needle in small pups. Seems to help!

[/quote]

Yes, but then you've got to follow that with a dirty great microchip needle!

[/quote] Agreed . Vivitreat broken up and wait till they are really chewing it before vacc. Also tend to wait till 2nd vacc before id chipping. Hopefully this may help in not immediately starting off with fearful association of vet table

RE: Lepto4 Vaccine

Bob Russell — Sat, 04 Feb 2017 10:56:46 GMT

No! Same price.

RE: Lepto4 Vaccine

David Mills — Sat, 04 Feb 2017 01:14:47 GMT

The lepto scare reminds me somewhat of lungworm a couple of years ago.

Not seen lepto for years, central London, never a metre away from a rat, still on L 2.

Worried well?

Have people increased their vaccine prices as well? Hmmm.

RE: Lepto4 Vaccine

ChrisBVSc — Sat, 04 Feb 2017 00:10:38 GMT

We used Versican L4 for a while & had a definite increase in injection site swellings & off colour pups for 24-48hrs post injection compared to previous L2 vaccines. Changed to Nobivac L4 probably 18 months - 2 years ago, havent had any further adverse events since & am not aware of any amongst colleagues. As per other posts all these reports of sudden death etc appear to be a load of scaremongering nonsense, in fact I believe the US Government approved terminology would be "Fake News!"

RE: Lepto4 Vaccine

Martin Atkinson — Fri, 03 Feb 2017 12:26:57 GMT

[quote user="Emily Rainbow"]Have to agree with Michael. I like to be up-to-date and best practice etc etc but currently don't see the indication to change. [/quote]I have a high proportion of Eastern European clients many of whom have passports and take their pets on home visits with them so L4 is more relevant. I was running L2 vaccines as well for those who don't want L4 because of reports of reactions but have now switched completely to Versican L4 as I see little point in keeping both. Maybe Merial's L3 is the right compromise but more significantly for me Versican has a CPV2b component which is the first UK vaccine to contain this and not before time.

RE: Lepto4 Vaccine

Robin Grimmer — Fri, 03 Feb 2017 12:24:21 GMT

[quote user="Emily Rainbow"]

I always try and tempt with biscuits whilst giving vacc and also use an orange needle in small pups. Seems to help!

[/quote]

Yes, but then you've got to follow that with a dirty great microchip needle!

RE: Lepto4 Vaccine

Virginia Campbell — Fri, 03 Feb 2017 11:14:16 GMT

[quote user="Beats"]I take from fridge and make up (perhaps I don't warm for long enough?)[/quote]

I take the bottles out of the fridge and call the client into the room with the bottles in my hand. My first question is "So how's the form with Miffy?" while observing the pup. If the owner doesn't say, "Oh well I'm glad he is in for his vaccines because I wanted to ask you, is it normal that he has vomited all night and hasn't eaten since yesterday?" and the pup looks OK at first glance I slip the bottles into my trouser pocket to warm up. Talk about pup source, do exam, draw up now-nicely warm vax with 21G needle then swap onto fresh 25G needle. Get O to feed treats while injecting pup. If pup, O and I feeling brave, then microchip. More treats and cuddles while filling in vax card and registering chip and talking about worming, training classes so by the time ready to go out the door, pup has forgotten inj +/- chip if they did notice it.

We still use L2 though so don't know if a difference.

RE: Lepto4 Vaccine

Pat Morris — Fri, 03 Feb 2017 10:38:51 GMT

Thanks Bob.

Pat

RE: Lepto4 Vaccine

Bob Russell — Fri, 03 Feb 2017 09:48:24 GMT

So far quite like the Merial LMulti. Has the three 'strains' that appear to be a potential issue in the UK and those travelling to most parts of Europe.

I don't know which of my patients will travel abroad so even this possibility seems enough to justify more than L2.

Nobivac does seem to sting and Versican more lumps. None have come to any harm!

RE: Lepto4 Vaccine

Emily Rainbow — Fri, 03 Feb 2017 07:11:51 GMT

I always try and tempt with biscuits whilst giving vacc and also use an orange needle in small pups. Seems to help!

RE: Lepto4 Vaccine

Kate Richardson — Thu, 02 Feb 2017 23:07:06 GMT

Occasionally get a delayed reaction to the vaccine (but not just the L4), assumed it was the cold? Never seems to last for long so haven't been worried about it.

RE: Lepto4 Vaccine

Beats — Thu, 02 Feb 2017 22:23:27 GMT

[quote user="Nicola Lawlor"]I personally don't find a particular problem in administering the vaccine and rarely get a patient reacting with pain from it.[/quote]

I wonder what I'm doing wrong. It is the mixed Nobivac DHPL4 in puppies under 12 weeks I have had problems with specifically. I take from fridge and make up (perhaps I don't warm for long enough?) and inject SC in scruff and wait and then they scream; when eventually they recover, I do the microchip and they occasionally react a little on insertion but generally nothing worth noting and never continue to react after the microchip has been placed.

Incidentally, does anyone else avoid injecting CKCS in scruff or am I imagining it also that they are more likely than other dogs to yelp when injected around the neck?

RE: Lepto4 Vaccine

Nicola Lawlor — Thu, 02 Feb 2017 22:15:02 GMT

We've been using Nobivac L4 for a few years now with one possible adverse reaction that we reported - lump at the site of vaccination. Very much doubt it was vaccine related as dog produces ridiculous amounts of scar tissue in response to any injury and suspect this was a part of what happened at the time of vaccination. I personally don't find a particular problem in administering the vaccine and rarely get a patient reacting with pain from it. I happily vaccinate my own dog with it.

RE: Lepto4 Vaccine

Pat Morris — Thu, 02 Feb 2017 22:14:49 GMT

Many thanks for all your replies and they mainly tally with my own thoughts. The stuff on the Internet re the adverse reactions is hysterically scary and has affected many of my forum pals decisions. However - I had no proof that any of the reports were anything but anecdotal - and that still seems very likely. I will probably have my own spaniel done with Lepto2 when the time comes.

Thanks for all input - much appreciated

Pat Morris

RE: Lepto4 Vaccine

Beats — Thu, 02 Feb 2017 21:21:02 GMT

[quote user="Kate Richardson"]Nobivac L4 used here since it came out so a few years now, not aware of any problems we have had with it[/quote]

About 80% pups yelp in pain (often uncontrollably) about 5-30secs after injection, or am I doing something wrong? The local lepto reference lab detailed bratislava circulating in dogs and I had one case with serological support of suspected bratislava infection (with no previous lepto vaccine history) that took 3 weeks with a feeding tube to sort its kidneys and I estimate probably treat about 3-4 presumed cases lepto per year, so was happy with annual lepto vaccines use of L4 to include bratislava. I'd not recommend Nobivac L4 though based on the pain it appears to inflict to puppies in my hands at least. Last confirmed case with attempt at typing I had in a farm puppy was hebdomadis - it got ill just after its 1st L4 vaccine, but clearly that wasn't to blame once investigated properly.

See https://www.afbini.gov.uk/articles/leptospirosis-laboratory-belfast for links to work on bratislava as pathogen for dogs in NI. PS - they do a very reasonable (most reasonable I've found by quite a way!) lepto screening serology for main strains in dogs if you wish to test clinical cases or do some screening on liver/kidney/pulmonary/low-platelet cases at your clinic to review your need for local vaccination - take serum at time of presentation (brown-top, clot, spin and freeze) and then again a week later and submit together - service is available UK-wide as I understand it, not just locally.

RE: Lepto4 Vaccine

Utlendigur — Thu, 02 Feb 2017 21:19:18 GMT

https://www.vetsurgeon.org/news/b/veterinary_news/archive/2016/07/06/140015.aspx

"In the 3.5 years since the vaccine was authorised, the incidence of suspected adverse animal reactions has been 0.064%. In other words, for every 10,000 doses sold, the VMD has received reports of 6 suspected adverse reactions. This incidence is considered 'rare', according to the following convention:"