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Veterinary Forum May 2009 (Vol 26, No 5)

Banfield changes vaccination protocols for 730+ hospitals

by Marie Rosenthal

    Banfield, The Pet Hospital, recently changed its vaccination protocols for dogs and cats, reducing the number of injections that patients receive by at least 25% — a significant reduction, as Banfield hospitals care for more than 5.5 million dogs and 1.1 million cats annually.

    "Each year we review our formulary, and it seemed like the right time to take a closer look at vaccines and move forward," said Karen Faunt, DVM, MS, DACVIM, in an interview with Veterinary Forum.

    Banfield is using the concepts of core and noncore vaccines, which have been adopted as part of the vaccination guidelines recommended by the American Association of Feline Practitioners (AAFP) and by the American Animal Hospital Association (AAHA). All recommended vaccines previously were considered core at Banfield, although individual veterinarians could decide whether an animal should receive a specific vaccine.

    "In the past, we had one national protocol for all pets and it was the doctor's responsibility to determine if an individual vaccine should not be given to a particular pet. Now, we are drawing attention to some vaccines by calling them noncore. For the noncore vaccines, each doctor will need to determine for each pet if it should or should not receive the vaccine. The intent is to have our doctors be more proactive in their decisions on vaccinating pets," said Faunt, who is vice president and chief medical officer at Banfield. "Deciding whether to give noncore vaccines depends on the lifestyle of the pet, the geographic location and similar variables."

    Banfield veterinarians encourage twice-yearly visits for all pets, and the new protocols are based on giving the vaccines over the two visits. The veterinarians also encourage the use of combination vaccines to lower the number of injections during each visit. "Our own data show that giving fewer injections lowers the vaccine reaction rates," said Faunt.

    Major changes to Banfield's canine protocol include the recommendation that makes coronavirus vaccine a core vaccine for puppies and then a noncore vaccine after the puppy series and first-year booster.

    Lyme disease and Giardia vaccines will be recommended, depending on the geographic prevalence data and exposure risk of the pet. "We are moving Lyme disease and Giardia to a noncore status and will provide information about prevalence, as well as information about risk assessment and lifestyle, so our veterinarians can decide whether to give these vaccines," Faunt explained.

    Banfield has removed Chlamydia vaccine from its feline vaccination protocols. Chlamydiosis is a disease of large catteries, which does not represent most Banfield clients, Faunt said.

    The feline infectious peritonitis (FIP) vaccine will now be recommended only as a noncore vaccine through the first-year booster for at-risk kittens and 1-year-old cats. It will not be recommended for adults older than 1 year.

    The FeLV vaccine is recommended as a core vaccine for kittens and noncore for adults, depending on the animal's lifestyle.

    "Feline leukemia is an important disease to vaccinate against, but kittens are most at risk. Usually by 1 year of age, you know whether it is going to be an indoor or outdoor cat, so the risk assessment gets easier. We wanted [this protocol to be] standard for all kittens, regardless of what the owner says about a kitten being indoor only," Faunt said, adding that because the lifestyle of the kitten could change over time, it is advantageous to vaccinate against FeLV at an early age.

    Banfield's protocols differ somewhat from the AAFP and AAHA guidelines, but the protocol committee felt there were good reasons for the variations.

    "For AAHA, coronavirus vaccination is not recommended for dogs. We are keeping it for puppies the first year because there are coronaviruses out there and we can protect puppies while their immune systems are developing and can give it in combination. We agreed [with AAHA] that in adults, it is probably not something that needs to be done," Faunt said.

    "AAHA includes leptospirosis as a noncore vaccine, but we are keeping it as core because it is a zoonotic. We want to minimize the risk to our clients from potentially lethal infection, so we disagree there," she said.

    AAHA and Banfield also disagree about the status of Giardia vaccinations, but Faunt said that the protocol group wanted more evidence about Giardia prevalence. "We know that we are one of the few [hospitals] giving Giardia vaccinations, but our doctors think it makes a difference, so let's find out and use our research team, DataSavant, to explore the hypothesis," she said. Depending on the results, this recommendation could change, which is an important aspect of Banfield's protocol review process.

    "We are working with DataSavant to see if we can find any evidence of whether the vaccine decreases clinical signs or infection rates. The protocol committee said, 'Let's keep it this year and investigate the questions. We will revisit the protocol after review of the study results.'"

    The protocols were made after a review of the veterinary literature, Banfield's own practice data, feedback from external experts on infectious diseases and vaccines and the AAHA and AAFP guidelines. She said that the protocols could change when new information becomes available.

    "It is okay to change your mind. New information becomes available every day. The decision you make today might not be the one you make next year.

    "I think we are at the point that vaccines have done so much good we forget these diseases exist. Viruses are out there waiting, and if we stop vaccinating and protecting our pets and families, the diseases can resurface again," Faunt said.

    The protocols became effective in April.

    NEXT: Better-behaved, better patients

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