Page 1480 - Small Animal Internal Medicine, 6th Edition

1452 PART XIV Infectious Diseases

respond appropriately to vaccination. Immunosuppressed tissues (Lappin et al., 2005), and some hypersensitized cats
animals, including those with FeLV infection, FIV infection, have developed lymphocytic-plasmacytic interstitial nephri-
VetBooks.ir canine parvovirus infection, Ehrlichia canis infection, and tis (Lappin et al., 2006b). The immunodominant cell line
antigen recognized by parenterally vaccinated cats is alpha
debilitating diseases, may not respond appropriately to vac-
cination, and modified-live vaccines could potentially induce
more et al., 2010). In people, anti-enolase antibodies are
the disease in these animals. enolase, which is present in all mammalian cells (Whitte-
If high levels of specific antibodies are present, efficacy of markers for immune-mediated disease, including nephri-
some vaccines is diminished. This is a particularly impor- tis. Whether postvaccination or naturally occurring anti-
tant consideration when vaccinating puppies or kittens from enolase antibodies are associated with nephritis in cats is
well-vaccinated dams. Disease may also develop in vacci- still being studied. Intranasal products can result in transient
nated puppies and kittens because infection had already sneezing and coughing, but in cats are not associated with
occurred and was incubating when the animal was vacci- the development of anti-enolase antibodies (Whittemore
nated. Vaccines can be rendered ineffective from mishan- et al., 2010).
dling. As most vaccine manufacturers will support their Suspected adverse reactions to vaccination should be
products if administered by a veterinary health care pro- reported to the vaccine manufacturer. Administration of any
fessional, it could be advantageous for owners to not pur- vaccine to animals with proven vaccine-associated sarcoma
chase and administer vaccines on their own. Vaccines should or immune-mediated diseases, such as immune-mediated
not be administered while the animal is under anesthesia polyarthritis, immune-mediated hemolytic anemia, immune-
because if a vaccine reaction occurs, clinical signs may not be mediated thrombocytopenia, glomerulonephritis, or polyra-
recognized. diculoneuritis, is questionable because immune stimulation
Adverse reactions can potentially occur with any vaccine. may exacerbate these conditions. However, the potential
However, they are relatively uncommon in dogs and cats and legal ramifications of waiving vaccination in these patients
recently have been reviewed (Gershwin, 2018). In a study should be discussed with the owners and with appropriate
of more than 1.2 million dogs, the overall rate of adverse state and county representatives when rabies vaccination is
reactions was 38.2/10,000 dogs that had received vaccines in question.
within the previous 3 days (Moore et al., 2005). In a study For some infectious agents, including canine distem-
of 496,189 cats, the overall rate of adverse reactions was per virus (CDV), canine parvovirus, feline panleukopenia
51.6/10,000 cats that had received vaccines within the previ- virus (FPV), feline calicivirus (FCV), and FHV-1, serologic
ous 30 days (Moore et al., 2007). In another study, vaccine test results have been shown to correlate to resistance to
associated hypersensitivity reactions were estimated at 6.5 disease after challenge in some studies. The advantages
per 10,000 vaccinated dogs (Yao et al., 2015). Vaccination and disadvantages of the use of serologic testing have been
has been associated with injection site sarcomas in some reviewed (Moore et al., 2004). If validated laboratories or
cats and can be life threatening. These tumors can occur kits are used, results can be used accurately to make vac-
after administration of infectious or noninfectious vaccines cination decisions for some dogs and cats (Lappin et al.,
(Dyer et al., 2009), but to date studies attempting to link 2002). For example, previously vaccinated animals that were
different vaccine types or individual products to tumor for- presumed to have had a vaccine reaction and are still at
mation have had variable results (Kass et al., 2003; Srivastav risk of exposure to infectious agents could be assessed by
et al., 2012). Injection site sarcomas have developed after serologic testing in lieu of arbitrary vaccination. In general,
administration of other substances including parasiticides, the positive predictive value of these tests is good (i.e., a
long-lasting glucocorticoids, meloxicam, cisplatin, antibi- positive test result usually predicts resistance on challenge)
otics, and microchips. It is apparent that tumor develop- for CDV, canine parvovirus, and FPV. Commercially avail-
ment may relate to a genetic predisposition, but P53 gene able kits for point of care testing are available in some
testing has not provided definitive results in all cases (Banerji countries.
et al., 2007; Mucha et al., 2012). Based in the information
available to date, it is impossible to determine the risk for VACCINATION PROTOCOLS FOR CATS
individual cats to develop injection site sarcomas, and the A physical examination, fecal parasite screen, and assess-
validity of current recommendations to avoid all adjuvants ment of vaccine needs should be performed at least yearly
have been questioned (Kass, 2018). Currently, the optimal for all cats. The AAFP formed a Feline Vaccine Advisory
way to avoid injection site sarcomas is to administer only Panel to produce vaccine recommendations for cats (http://
products absolutely indicated by this route, including using www.catvets.com) in 2013 (Scherk et al., 2013). These guide-
the longest vaccination interval acceptable for the vaccine lines are an excellent source of information for veterinar-
used. In addition, if a cat has previously developed an ians when individualizing vaccination protocols. Vaccine
injection site sarcoma, it is likely of risk of developing a antigens were divided into those that were considered core
second tumor, and parenteral injections should be avoided (FPV, FCV, FHV-1) and noncore (rabies, FeLV, FIV, B.
if possible. bronchiseptica, Chlamydia felis, and feline infectious peri-
Feline vaccines for which the viruses were grown on cell tonitis [FIP]). In contrast to previous AAFP Panel Reports,
cultures induce antibodies that cross-react with feline renal rabies vaccines are no longer considered core because the