To titer or to revaccinate?
When and why has it become more common for veterinarians to measure antibody titers when deciding whether to revaccinate cats and dogs?
An antibody titer is a measure of the concentration of antibodies in the blood, as determined by a test involving repeatedly diluting a blood sample and exposing those dilutions to an antigen. The shorthand is to refer to all measurements of antibody concentration as titers.
Dr. Richard Ford, emeritus professor of internal medicine at the North Carolina State University College of Veterinary Medicine, said factors inside and outside the profession are driving the increase in antibody titer testing.
In the late 1990s and early 2000s, the American Association of Feline Practitioners, AVMA, and American Animal Hospital Association released guidelines on vaccination suggesting that core vaccines have a longer duration of immunity than one year. The AAFP and AAHA guidelines recommended vaccinating every three years. Dr. Ford said many practices began measuring titers “to provide evidence to themselves that in fact the vaccinations are lasting longer than one year.”
Part of the impetus for the guidelines was concerns about the potential adverse effects of vaccines. Recently, Dr. Ford said, concerns about adverse effects of vaccines in children have spilled over into veterinary medicine.
The technology for measuring antibodies also has improved, he said. There are now affordable point-of-care test kits that provide useful information within 20 to 25 minutes. For all forms of antibody testing, though, it remains confusing and even controversial whether the results are a good measure of immunity.
Antibody testing is useful for monitoring immunity to certain viruses in dogs, according to the current AAHA guidelines. The AAFP guidelines recommend defined revaccination intervals for cats. Guidelines from the World Small Animal Veterinary Association favor antibody testing for determining duration of immunity of core vaccines in dogs.
According to the current AVMA “Vaccination Principles”: “When serological titers are used to help determine the vaccination/protection status of an animal, veterinarians should make sure these data have been clinically correlated to host-animal protection studies for the specific diseases and species being tested. For most common vaccine antigens, the correlation between serological response to vaccination, long-term serostatus, and protection in the host animal has not been adequately established. The lack of these data often precludes practitioner's ability to make well-informed vaccination decisions based on serostatus alone.”
Dr. Laurel Gershwin, a professor who teaches immunology at the University of California-Davis School of Veterinary Medicine, represents immunology on the AVMA Council on Biologic and Therapeutic Agents, which has oversight of the “Vaccination Principles.” The principles don't make recommendations on specific vaccines or specific vaccination intervals, but Dr. Gershwin said there are good data that immunity from core vaccines in cats and dogs should last for three years.
“For those clients that are reticent about not having a distemper vaccine every single year, for example, those are a great indication to go ahead and do a titer,” she said. “Having said that, when we measure antibody, antibody is only part of the equation.”
A cat or dog could respond to a vaccine with a strong cell-mediated immune response, which is difficult to measure outside a research setting. She said, “Even if you have a titer that is less than what is considered acceptable, that doesn't necessarily mean that the pet would get sick if he or she were challenged with just the street virus, walking down the road and sniffing noses with a dog that was infected, for example. But, obviously, one would want to boost those.”
Condensed from July 1, 2016, JAVMA News
AVMA launches database of clinical studies
The AVMA launched the AVMA Animal Health Studies Database in June as a resource for researchers seeking animals to participate in clinical studies and for veterinarians and animal owners exploring options for treatment.
Until now, there really haven't been any national databases for veterinary studies, other than the Veterinary Cancer Trials website focusing on cancer in cats and dogs, said Dr. Ed Murphey, an assistant director in the AVMA Education and Research Division. The new AVMA website encompasses all fields of veterinary medicine and all species of animals and will extend beyond the United States to Canada and the United Kingdom.
At the University of Missouri College of Veterinary Medicine, associate teaching professor Dr. Kim A. Selting (left) and technologist Joni Lunceford prepare a dog for positron emission tomography as part of a clinical trial. Photo by Karen Clifford/University of Missouri
Citation: American Journal of Veterinary Research 77, 8; 10.2460/ajvr.77.8.792
“There are a lot of AVMA members that are involved in the conduct of clinical studies, and so, having the database helps them enroll animals into their studies,” Dr. Murphey said. “And there's a direct benefit to practitioners who are looking for all avenues to help some of their owners and patients.”
He continued, “Then there is an indirect benefit, too, and that's the advancement of evidence for the practice of veterinary medicine. Clinical studies, in particular clinical trials, are really the most informative and most scientifically accepted evidence for whether things work or don't work in clinical practice.”
The new database is the brainchild of the AVMA Council on Research. A working group studied the feasibility of a national registry of veterinary clinical trials, then expanded the concept into a clinical studies database. The database covers not only randomized controlled clinical trials but also prospective clinical studies and survey and epidemiological studies.
The AVMA Animal Health Studies Database is at www.avma.org/FindVetStudies.
Condensed from July 15, 2016, JAVMA News
High blood lead found in some Flint dogs
Four of 320 dogs tested in Flint, Michigan, had blood lead concentrations indicating toxicosis.
Dr. Daniel K. Langlois, an assistant professor at Michigan State University College of Veterinary Medicine, is the lead clinician for a study that involved conducting six screening clinics in Flint. He said the four dogs with lead toxicosis had concentrations of more than 50 ppb, the concentration requiring a report to the state. Up to 20 others had higher than typical concentrations of 25 to 45 ppb.
Veterinary technicians draw blood for a lead exposure test this May in Flint, Michigan Courtesy of Emily Lenhard/MSU CVM
Citation: American Journal of Veterinary Research 77, 8; 10.2460/ajvr.77.8.792
For comparison, university staff conducted tests on dogs in East Lansing, where few had more than 10 ppb of lead and many had less than 2 ppb, the quantitation threshold of the assay used in the screenings.
Testing began several months after the initial news of lead contamination in city water, Dr. Langlois said. About 75 or 80 percent of dog owners in Flint who were surveyed through the screening clinics indicated they had been giving their dogs bottled or filtered water.
Of the dogs screened through the clinics, two had clear clinical signs through behavior changes and seizures, he said.
Dr. James Averill, Michigan's state veterinarian, said that, including the dogs screened by MSU, the state had received reports of seven dogs meeting the definition for lead toxicosis. He said some cats have been tested, but none had levels meeting the definition for toxicosis.
Condensed from July 1, 2016, JAVMA News
Pet treats remain source of illnesses
Dogs are still becoming ill after eating jerky-type treats, although illness reports have declined.
The Food and Drug Administration received about 200 reports of illnesses associated with such treats in the last quarter of 2014 and all of 2015, according to a mid-May announcement. Since 2007, the agency has received about 5,300 reports of illnesses associated with pet treats made of chicken, duck, or sweet potatoes.
Those reports have described illnesses in more than 6,200 dogs—of which more than 1,100 died—as well as in about two dozen cats and three people.
FDA information states that most of the illnesses and deaths are connected with treats imported from China, but manufacturers are not required to list the origins of each ingredient. The FDA's investigation has yet to reveal a cause for the illnesses.
The volumes of reports peaked in 2012 and 2013, when about 1,900 reports were filed in each year. But about 1,600 of the 2013 reports arrived in the fourth quarter of that year, following an October 2013 request from the agency to veterinarians for reports of sicknesses in animals that may have been caused by jerky-type treats.
The volume of illness reports declined to fewer than 500 in all of 2014.
Condensed from July 1, 2016, JAVMA News
Salary threshold for overtime pay doubles
Starting Dec. 1, exempt salaried employees earning less than $47,476 a year will qualify for time and a half when they work more than 40 hours a week. The previous threshold to qualify for overtime pay for these workers, last set in 2004, was $23,660.
The Department of Labor issued the highly anticipated overtime rule May 18, updating the regulations governing exemptions to the Fair Labor Standards Act's overtime pay requirements.
Veterinary practices will see an impact with salaries paid to practice staff who make less than $47,476 and are currently exempt, most likely practice managers, bookkeepers, or human resources directors. The Labor Department has specifically ruled that veterinary technicians are nonexempt, so they historically have been eligible for overtime.
Small businesses such as veterinary practices won't be the only ones impacted.
Faculty members are exempt from overtime; however, the new salary threshold does apply to postdoctoral fellows who do not primarily teach. Thus, the new regulations will likely result in raises for a lot of postdocs. That said, veterinary interns and residents likely will not be affected by the new rule, as they could fall under two exemptions.
Nonprofits, too, could be impacted. The Labor Department, in a fact sheet published this past year, said that nonprofits that have revenue from sales or business of at least $500,000 were covered under the Fair Labor Standards Act.
Employees engaged in commercial activities are protected by the FLSA, while those performing the organization's charitable activities are not covered on an enterprise basis, as those activities do not have a business purpose.
Condensed from July 1, 2016, JAVMA News
Notifications available for equine disease outbreaks
Horse owners, veterinarians, and other equine industry stakeholders can be alerted to infectious disease outbreaks and updates through an email notification system recently implemented by the Equine Disease Communication Center. So far, its website, www.equinediseasecc.org, has posted about 195 alerts since going live in 2014; 90 of those alerts were since the first of this year. The aim is to mitigate the health, welfare, and economic implications of these events for U.S. horses and the industry as a whole.
The center's Outbreak Alert email service, which began in earnest earlier this year, advises subscribers when an infectious disease outbreak is confirmed or there is an update, such as when a quarantine has been lifted.
The EDCC website aims to get information out as soon as an outbreak has been confirmed by diagnostic testing or, in the case of reportable diseases, has been reported.
The website also includes comprehensive information concerning diseases, vaccinations, and biosecurity as well as contact information for state veterinarians' offices. The EDCC is based in Lexington, Kentucky, at the American Association of Equine Practitioners' headquarters, with website and call center hosting provided by the United States Equestrian Federation.
Donors and volunteers representing all areas of the equine community support the Equine Disease Communication Center activities and functions, which are facilitated through the AAEP Foundation.
Condensed from July 15, 2016, JAVMA News
The slow rise of generic animal drugs
In human medicine, generic drugs accounted for 88 percent of prescriptions dispensed in the United States as of 2014. Currently, generic animal drugs account for only a small percentage of the drugs that the Food and Drug Administration has approved for cats and dogs.
For the most part, veterinarians rely on costlier brand-name animal drugs and on extralabel use of brand-name and generic human drugs to treat cats and dogs. But the number of generic animal drugs for cats and dogs is slowly on the rise, with the FDA approving 22 between 2013 and 2015.
Brakke and Trone Brand Energy Inc. released the Pet Pharmaceutical Market Study in April 2015. Part of the study addressed generic drugs. In a survey of 785 pharmacists in human medicine, 88 percent who received a prescription for a brand-name pet medication would recommend a generic for the pet owner's consideration, if a generic equivalent were available.
In a survey of 520 veterinarians, 80 percent reported that they were adding generic drugs to their pharmacy to save clients money. More than half were adding generics to increase margins. All expected to offer more generics in the future.
Among other barriers, generic drugs have lower profit margins for manufacturers than brand-name products do. Health insurance drives the market for generic drugs in human medicine, but few pet owners have pet health insurance. Plus, there is much more money to be made in human medicine than in veterinary medicine, contributing to the overall lack of animal drugs.
Condensed from July 1, 2016, JAVMA News
Research distinguishes between injuries from accidents, abuse
In dogs and cats, blunt force trauma causes different types of injuries depending on whether the trauma is accidental, according to research from Cummings School of Veterinary Medicine at Tufts University and the American Society for the Prevention of Cruelty to Animals.
The findings may help veterinarians distinguish accidental injuries from animal abuse. Motor vehicle accidents, for instance, are often falsely cited when it's abuse that caused skeletal injuries. The study compared records from 50 criminal cases of abuse provided by the ASPCA with records of 426 cases of motor vehicle accidents from the Cummings school.
Abused animals generally had more head injuries and rib fractures as well as tooth fractures and claw damage. Pets involved in motor vehicle accidents tended to suffer skin abrasions or injuries involving tearing of the skin from underlying tissue, lung collapse and bruising, and hind end injury, the last possibly as a result of running away from a moving vehicle.
A clear difference in rib fracture patterns was found, with abuse injuries generally causing fractures on both sides of the body, while rib fractures caused by motor vehicle accidents tended to appear on only one side of the body, with the ribs closer to the head more likely to be fractured. Evidence of older fractures was more likely to be found in victims of nonaccidental injury.
The Journal of Forensic Science published “Characterization and comparison of injuries caused by accidental and non-accidental blunt force trauma in dogs and cats” online ahead of the September print edition. The study is available at http://jav.ma/dogcattrauma.
Condensed from July 15, 2016, JAVMA News
Nov. 3 is One Health Day
The One Health Commission, One Health Initiative team, and One Health Platform encourage individuals and groups worldwide to mark Nov. 3 by implementing one-health projects and hosting special events under the auspices of One Health Day. Projects should highlight the benefits of using transdisciplinary approaches to complex challenges involving animals, people, and planetary ecosystems.
Participants should register their event at www.onehealthcommission.org and use the guidelines on the site to plan their event. Student groups from all disciplines are encouraged to participate and will have the option of competing for cash prizes and global recognition.
“It is anticipated that emerging projects will focus on many of the arenas under the One Health umbrella including worldwide public health issues such as emerging/reemerging zoonotic infectious diseases, comparative medicine research including cancer, heart disease, orthopedic diseases and the inextricable interactions between animal, environmental and human health,” said Dr. Cheryl Stroud, executive director of the One Health Commission, in an announcement.
One health is a movement to forge collaborations in research and applied sciences among human and veterinary health care providers, social scientists, dentists, nurses, agriculturalists and food producers, wildlife and environmental health specialists, and those in other related disciplines.
“The One Health approach is being increasingly accepted by numerous major international health oriented organizations such as the World Health Organization, the World Medical Association, the World Veterinary Association, the Food and Agricultural Organization of the United Nations, the World Organization for Animal Health, and many others. An outstanding group of One Health textbooks and international professional One Health journals have emerged,” explained Laura Kahn, MD, co-founder of the One Health Initiative team.
Condensed from July 15, 2016, JAVMA News
Accreditation status remains uncertain for Arizona
The University of Arizona Marley Foundation Doctor of Veterinary Medicine Program announced May 31 that it would postpone its plans to open its doors until fall 2017. The move comes as the AVMA Council on Education, the accreditor of veterinary colleges, reviews the report from a COE site team that visited Arizona. The university's proposed School of Veterinary Medicine cannot admit students without a letter of reasonable assurance of accreditation.
A council site team traveled to Tucson, Arizona, for a comprehensive site visit Jan. 24–28 of this year. That visit is the final step before the council makes an accreditation decision, which could have happened for UA at the March 20–22 COE meeting. However, the council has a policy that decisions arising from site visits that occur less than 90 days prior to the next scheduled COE meeting will usually be deferred to the following meeting. The council next meets Sept. 25–27.
The veterinary school announced in a May 31 email that instead of opening the program this fall, it would wait until it has a definitive decision from the COE, with the new target to open the program's doors in fall 2017.
“We have proposed a major paradigm shift in how future veterinary medical practitioners will learn and we expect the AVMA Council on Education will be diligent in review, in part because of the innovations we propose,” according to the letter by Dr. Shane C. Burgess, interim dean of the veterinary school.
Condensed from July 15, 2016, JAVMA News
