Abstract
In this issue of the Journal of Feline Medicine and Surgery we are delighted to be able to reproduce, in full, the 2000 Report of the American Association of Feline Practitioners and Academy of Feline Medicine Advisory Panel on Feline Vaccines. This is an important and influential paper and we are very grateful to the AAFP for allowing it to be reproduced in the JFMS. Some of you will have already seen this paper, but even if you have not had an opportunity to read this previously, I doubt that there is anyone unaware of the considerable debate that has gone on over both the frequency and necessity for vaccination in recent years.
A large panel of leading experts has produced this report, and it represents a true ‘state of the art’ document. While not everyone will agree with all of the conclusions and recommendations made in the report, they cannot be lightly dismissed, as it represents a genuine attempt to add scientific credibility to recommended vaccination regimes. Some of the information contained in the document is also specific to the United States — particularly, for example, information on licensing and efficacy testing. Although such information is not necessarily directly applicable to the situation in other countries, this does nevertheless stimulate the reader to want to know more about the legislative process governing the products they have access to.
We are undoubtedly in a period of significant change with respect to the use of small animal vaccines. Whilst more information and more data are required to fully assess optimal vaccination protocols, this is not an excuse to avoid any change. There is no doubt that as time goes by and more data become available, the recommendations in this report will be altered and refined, but there are significant data available now to substantiate these current recommendations.
The debate over the frequency of vaccination has been driven by two main concerns — first the increased recognition of side effects associated with the use of vaccines, and second questions over the scientific merits of annual vaccination policies. However, quite apart from specific recommendations over the frequency of vaccination, this panel report raises at least two other very important issues worth highlighting.
The first of these relates to the use of monovalent and multivalent vaccines. While multivalent vaccines (eg, ‘5 in 1’ products) offer a certain amount of convenience when administering the product, this convenience can have a significant trade-off. It is noted in the report that increasing the number of antigens in a vaccine is, in general, likely to increase the probability of adverse reactions occurring. However, possibly of greater concern is that the use of multivalent vaccines may be associated with the administration of antigens not needed by an individual patient. Thus while FPV, FCV and FHV-1 vaccination can be recommended in all cats, other vaccines should be used more selectively and only where required (eg, by legislation or by a genuine risk of exposure to an agent against which the vaccine is efficacious). This concept of ‘core’ and ‘non-core’ vaccines is an important one — it encourages us to consider the individual needs of our patients, to offer our clients genuine choice, and to adjust our vaccine recommendations accordingly. It is difficult, therefore, to find a rational argument against the panel recommendation that the use of multivalent vaccines, other than those just containing FPV, FCV and FHV-1, should be discouraged.
The second issue centres on client communication. The report suggests that vaccination needs for individual cats should be evaluated at least on an annual basis, that clients should be informed of both the risks and benefits of vaccination, and that clients should be informed about the specific infectious diseases involved including an assessment of the risk of their cat being infected and the likely protection afforded by vaccination. Finally the report states that ‘though the judgement and counsel of their veterinarian will guide them, clients should understand that the decision to vaccinate their pets remains with them’. This is a simple but very important statement. We have a duty of care for our patients and our clients, and this is not served by the habitual administration of a multivalent vaccine on an annual basis. On the contrary, we need to be familiar with the diseases for which we offer vaccination, we need to be able to explain and justify why we consider vaccination against any individual disease to be important, we should discuss the risk-to-benefit ratio, and we also need to be able to provide rational argument for the frequency of vaccination that we recommend. Genuinely informed owner consent for vaccination is as important as for any other procedure we undertake. These are complex but vitally important issues, and this is why the panel report is such a significant document.