Vaccine strategies that minimize risk and maximize owner involvement.
As more evidence emerges about vaccinosis and acute reactions to vaccines, many horse owners are questioning the need for giving vaccines as often as some veterinarians, barns, shows and transportation issues require.
These concerns are reflected in the integrative veterinary community as well, with many veterinarians seeing clear relationships between increasing chronic illnesses in animals and the frequency and number of vaccines (read Dr. Lankenau’s article, IVC Spring, 2014). Dr. Jean Dodds’ articles in previous issues of IVC (Summer and Fall, 2012) outline the considerations for vaccinating horses for specific illnesses, and provide a review of the immunology many of us have forgotten.
So what happens when owners and veterinarians agree to vaccinate less, but circumstances seem to demand the opposite? What strategies can be used to avoid some vaccines, help caregivers decide which vaccines to give, and mitigate any potential harm that might arise from these decisions?
IVC talked to integrative veterinarians in different zones and types of practice about the protocols they use. All the veterinarians agree on several points:
• Vaccines are responsible for many of the chronic illnesses affecting their equine patients, so they look for the minimum possible vaccines to administer.
• Vaccine timing is important. To avoid stress, the veterinarians spread out the vaccines, avoid giving a vaccine when a horse is ill and administer when most needed.
• Owners should be educated to carefully observe their horses for any health changes secondary to vaccines. If health changes are noted, treatment should be started promptly.
• It’s incumbent upon the veterinarian to educate clients about their choices.
So which vaccines are integrative veterinarians recommending?
Equines experience disease incidence differently depending on lifestyle and where they live. We asked veterinarians around the country to weigh in on what they recommend. Due to the housing situation of their patients, the horse’s owner may or may not be able to follow their recommendations.
Dr. Joyce Harman – Virginia
Equine flu is easy to treat with alternative medicine, and symptoms are not lethal, so she does not recommend this vaccine.
Rabies is life-threatening, difficult to treat and the vaccine is highly effective, though often causes chronic illness. Only one or a few shots in the lifetime of the horse will be protective for most animals. Most horses in her practice have titers thousands of times higher than the protective level needed in humans.
Potomac Horse Fever vaccines fall somewhere in the middle. The vaccine has not been shown to have complete protection, or the disease would have been eliminated. Many of her patients live along a major river basin (the Potomac), and cases are seen each year, so vaccination may be wise. This vaccine does not appear to be as hard on the horses as some others. Titers are often seen at a protective level without constant revaccination.
Tetanus is a high-risk, difficult to treat and prevalent disease. The vaccine seems quite safe, though does not need to be given annually.
Strangles is a highly contagious disease, not usually life-threatening if the animal is cared for well, and fairly easy to treat with both alternative and Western medicine. The healthier the horse’s immune system, the less likely he is to get sick, and the easier it is for him to make a full recovery. The vaccine seems to cause more problems than any other vaccine, so Dr. Harman does not recommend it.
Dr. Jane Laura Doyle – Berkley Springs, West Virginia
She recommends rabies (not legally required) and tetanus only. She will let the owner give the vaccines so they can be given several weeks apart. Most of her clients are at their own barns.
Dr. Madalyn Ward – Fischer, Texas
Dr Ward recommends the two combination encephalitis/ tetanus vaccinations at six months of age, and boosting every three years or sooner if there is an outbreak, until 15 years of age.
Dr. Marge Lewter – Southwest Virginia
She administers the combination encephalitis/tetanus and rabies as core vaccines. Rabies titers can be done but rabies is a real risk to horses in her area. If the horse travels and the owner requests it, she may add West Nile (endemic, and most horses have titers to it), Potomac Horse Fever (if the horse lives on a river and it is a serious illness), and/or strangles. She splits the vaccines into two visits.
Dr. Ann Schwartz – Southern Oregon
Dr. Schwartz lives in an area where Potomac Horse Fever and West Nile are endemic. Foals get an initial vaccine and a booster of Potomac Horse Fever and West Nile, then no more. (Exception: there is one stream area that seems to be flowing with Potomac Horse Fever. One owner has had it in her horses twice, so she vaccinates for it about every five years with Dr. Schwartz’s approval.)
Foals get a series of two vaccines of Eastern and Western encephalitis and tetanus at four to six months, two to four weeks apart, and boosts to the comfort of the client. Most of her clients choose annual (not many), some bi-annual, some every five years or less. Dr. Schwartz tries to give tetanus before gelding. She does give boosters after any open wounds that could come in contact with dirt or stool.
She does not recommend rhino, though some clients give it before going to a training barn. She also does not recommend strangles vaccine, telling owners to avoid infected barns. Rabies is given once only, if clients wish.
Integrative veterinarians agree there are safer ways to administer vaccines, even in boarding settings, as well as handle possible side effects.
Veterinarian Dr. Lisa Melling of Willis, MI was able to manage barn vaccine requirements (EEE, WEE, Potomac, tetanus and EHV) for her own leased horse by spacing them out every two weeks. Since the horse is allergic to flies, he would not really be considered healthy enough to be vaccinated per the vaccine label, but with homeopathic care seems to tolerate the vaccine.
Dr. Harman reminds us that vaccinating in May is good for the mosquito-carried diseases that occur primarily when the mosquito population builds to high levels in the late summer and fall. The same is true of Potomac Horse Fever, which also occurs in July through October. Rabies and tetanus are yeararound diseases, so these could be given at any time of the year. Educating clients about the timing of illnesses can help owners and barn managers feel comfortable only giving the vaccine once a year. Dr. Harman follows vaccines with a homeopathic remedy, Ledum. Other homeopathic veterinarians use other remedies or wait until symptoms appear. Reiki is used by many owners and practitioners to decrease reactions – first on the syringe itself, then at the injection site, and finally to the whole horse as long as is needed.
Barns and other requirements can be fulfilled with titers. Some university vaccine researchers feel that if any titer is present at all, there will be protection at the cellular level. Even animals with no titer may be well protected. Holistic veterinarians agree that the healthiest horses are the least likely to acquire infectious illnesses, or at least will usually recover more easily.
Michelle Brim, DVM, of Webster City, Iowa, had an ambulatory practice for 15 years doing conventionally frequent vaccines. After observing some health issues and reading about individualizing vaccines, she gave fewer to her own horses, followed by titers only for seven years. Since her horses had protective antibody titers, she began to convince clients to do either titers or change to a three-year vaccination protocol for encephalitis/West Nile. For flu and herpes, she evaluates the horse’s activity and housing.
Tips on educating clients
Veterinarian Joyce Harman feels it’s important to include the horse owner in the vaccine decision process. She helps the owner evaluate:
1. The risk and severity of the illness
2. The efficacy, duration and potential damage for each vaccine
3. Ease of treatment
4. Availability of titers
5. The horse’s lifestyle
The joy of an integrative practice is that we offer our clients choices based on each individual’s needs. We realize that every choice, including those about vaccines, diet, and treatments, impacts the horse’s health. As more and more vaccines are developed, owners are often concerned about the health damage to their horses. By educating the owners and tailoring the vaccine schedule to the needs of the horse (rather than the barn), and treating sequela promptly, horses can retain their health.