Veterinarians and pediatricians have a great deal in common. Both are highly qualified medical professionals with similar years of education. Both often struggle to determine what is wrong with their patients since pets, like little people, cannot communicate what hurts. Their jobs are not easy, but the premise of their work is simple: Support the health of those in their care and abide by the oath: "First, do no harm."
Wellness checkups for babies and pets are often synchronized with routine vaccination schedules. Before a shot is given, the consent of the caretaker is required. For human patients, this is where discussions with the doctor can turn dark. Parents are aware of others who have been discharged from a medical practice for questioning vaccines and are wary of bringing up their concerns. Their fears are not unfounded. According to a 2005 survey of the American Academy of Pediatrics (AAP), when faced with parents who refuse immunization, pediatricians reported that they always (4.8 percent) or at least sometimes (18.1 percent) tell parents that they will no longer serve as the child's physician. Pet owners, on the other hand, have latitude to discuss their vaccination concerns. In many cases, refusing a vaccination has the full support of their vet.
When it comes to dogs, veterinarian professionals can tailor the vaccination schedule to the pet. The Canine Vaccine Guidelines and Recommendations offer suggestions about shots for puppies and adult dogs. Vaccines are categorized as core (recommended for all dogs); non-core (those that are optional); and not recommended (due to poor efficacy and unacceptable risk of side effects). The guidelines recognize vaccination as a medical procedure that needs to be individualized based on the animal's geographic and lifestyle exposure. Veterinarian professional organizations allow flexibility and encourage doctors to extend vaccination intervals whenever necessary for the safety of the pet.
Most veterinarians agree house pets should be assessed yearly and vaccines - if given at all - should be tailored to an animal's age, health, and lifestyle. For example, Dr. Matthew J. Toia, Chief Veterinarian Officer for PetLabsMD.com ("Pet-Labs"), a national direct to consumer animal health wellness testing laboratory staffed by licensed veterinarians and veterinary technicians, concurs. "An indoor cat with limited exposure to some diseases may never need some of the common vaccinations. For instance, Lyme's disease, a regional illness for outside pets in endemic areas, is not necessary for unexposed animals in low risk regions of the country. Cats can forgo this vaccine without an issue."
His comments are supported by two veterinary associations, the American Association of Feline Practitioners (AAFP) and the Academy of Feline Medicine (AFM). The Advisory Panel on Feline Vaccines (APFV) has guidelines for the selection and administration of vaccinations for cats. Feline shots fall into two basic categories: core vaccines (those recommended for most cats), and ancillary vaccines (those recommended for only a small percentage of cats.) Both of these organizations encourage cat owners to develop a good relationship with their veterinarian so their cat's vaccination schedule can be openly discussed.
Veterinarians limit the number of vaccines given to puppies on a single visit. A study of more than 1,200 dogs found evidence that the risk of a vaccine-associated adverse event was significantly increased as the number of vaccine doses administered per office visit increased; each additional vaccine significantly increased risk of an adverse event by 27 percent in dogs under10 kg (22 lb) and 12 percent in dogs over 10 kg. Vets are cautious about giving multiple vaccines on one office visit.
Unlike their animal doctor counterparts, the American Academy of Pediatrics (AAP), endorses universal immunization and follows a one-size-fits-all vaccination schedule. The AAP not only assumes that all vaccines are necessary, pediatricians assume that children can all equally tolerate all vaccines given in the standard schedule. As many as six doses - and 18 vaccine antigens - can be given at the same time. The Advisory Committee of Immunization Practices (ACIP) recommends that if a dose is not administered "on time" at the routine two, four and six month checkups, the shot should be given at the next visit. Every dose is considered to be so essential that the ACIP has created a 'catch up' schedule for children who have missed even one shot.
Parents have become alarmed by the large number of injections given at one time. To by-pass their psychological concerns, manufacturers have created combination vaccines, such as Pediarix and Comvax, to trick parents into believing that their baby is "only" getting one shot at a time. Pediarix is actually three vaccines in one shot (DTaP, hepatitis B and polio) and Comvax combines the hepatitis B and HiB vaccine into one shot. The ACIP states that, "The use of combination vaccines is preferred over separate injections of its equivalent vaccine components". The AAP backs up this recommendation, urging combination vaccines to "improve timely vaccination coverage." Both ACIP and AAP overlook a potentially serious problem with combination shots: If a reaction occurs, it is impossible to determine which vaccine caused the side effect. Animal doctors have figured this out. The Association of Feline Practitioners (AAFP) recommends using single dose vaccines because "increasing the number of antigens in a vaccine also increases the probability associated adverse events."
Most pediatricians seem to have a "vaccinate no matter what" approach to childhood immunizations rather than ensuring the safety and appropriateness of the individual child. The AAP encourages pediatricians to "work individually and collectively at local and national levels to ensure that all children receive all childhood immunizations on time." This includes giving vaccines to children, even when they are sick. According to the most recent "General Recommendations for Vaccination", published in 2006 by the Centers for Disease Control (CDC), there are few reasons for delaying vaccination. In fact, the guidelines state, "Among the most common conditions often inappropriately considered contraindications are diarrhea, minor upper-respiratory tract illnesses (including otitis media) with or without fever, mild-to-moderate local reactions to a previous dose of vaccine, current antimicrobial therapy, and the convalescent phase of an acute illness." Pediatricians, at the behest of the CDC and the AAP, follow the CDC's instructions to use of every encounter as an opportunity to vaccinate.
When animals are sick, most vets choose to err on the side of safety. Vaccines are delayed until the pet is healthy to minimize the risk of a reaction. According to PetEducation.com, the decision to vaccinate a sick animal should be made on an individual basis. The vet determines if a shot is appropriate by performing a physical examination and possibly obtaining laboratory tests to aid in the decision. Not so with children. According to the CDC, a routine physical exam and taking a temperature is no longer a prerequisite before vaccinating. If a child appears in the doctor's office, vaccination should proceed.
Avoiding over-vaccination: Vaccine Titers
Many vets are concerned about the potential for side effects and complications from unnecessary shots and boosters. They order a blood test, called a titer, to determine the need for additional vaccinations. A vaccine titer is test that measures the level of an antibody in the blood, a component usually induced by vaccination. A titer is reported as a ratio of one to a number. The higher that number, the better. For example, a titer of 1:5 is a low titer, and generally implies a susceptibility to disease. A titer of 1:1,000,000 is a very high titer, and implies immunity. It is generally accept that a high titer indicates further vaccination is unnecessary.
While useful as a guide, titer levels have limitations. They only measure one component of the immune system so the level of full protection is unknown. Antibodies cannot be distinguished between those generated by vaccination from those developed after recovery from a disease. Except where vaccination is required by law, all animals can have serum antibody titers measured to determine the need for booster shots. Testing is especially important for pets that have previously experienced an adverse reaction. While not all vets agree with checking antibody titers, the test is available for pet owners who prefer not to follow the conventional practice of annual boosters.
While veterinary medical associations are advocates of vaccination, they insist that immunization is only one component of an individualized, health-care plan for pets. One organization that wants to assist owners in their quest for healthy pets is PetLabsMD.com, the first and only national company to offer consumer-direct laboratory testing. Pet owners can actively participate in the health and wellness for their pets. Tests can be ordered directly through the internet by owners at substantial savings. PetLabsMD.com offers hundreds of screening tests, from preventive profiles for cancer, to tests for infectious diseases, diabetes, nutritional deficiencies, and vaccination titers.
Most importantly, owners will have the added convenience of having their pets' blood tests done in the privacy of their own homes, avoiding the added stress of taking a pet to the vet. PetLabsMD.com is expanding their nationwide network of veterinarians and veterinary technicians who will come directly to your home to draw the necessary samples. Pet owners without access to a holistic veterinarian can order important health tests directly from Pet-Labs.
Vets vs Peds: A Interesting Comparison
Unlike the AAP that routinely denies any connection between vaccines, adverse events and side effects, the Council on Biologic and Therapeutic Agents (COBTA) at the American Veterinary Medical Association concludes that vaccines can cause problems and should be individualized. The following is an excerpt of their policy:
"There are insufficient data available to scientifically determine a single best vaccination protocol regimen for application to all animals globally. Despite significant advances in our knowledge of antigens and antigen presentation, gaps still remain in our under-standing of the immune system's acute and chronic reaction to multiple vaccinations. The body of knowledge surrounding the genetic variability within individual breeds or species and the resulting idiopathic responses to vaccination (including vaccine-associated adverse reactions), is increasing but remains too inconclusive to make specific recommendations appropriate for all patients. Consequently, COBTA believes that a customized approach to recommended vaccination protocols is the safest and most effective method to medically address the increasing diversity in patients presented for immunization."
It appears that veterinarians are more prudent about vaccination than their pediatrician counterparts. A comparison of Vets to Peds can be summarized as follows:
It's time for pediatricians, the AAP, the CDC, the ACIP and all others involved with human vaccination programs to acknowledge that vaccines have risks and can cause serious harm, including death. If animal doctors can work with owners to individualize vaccination schedules, to avoid over-vaccinating though vaccine titers, and to encourage participatory care, human doctors need to start doing the same. Parents need to demand care that is as good for their children as it is for their pets.
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