{"id":1106,"date":"2014-01-01T15:59:21","date_gmt":"2014-01-01T15:59:21","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1106"},"modified":"2022-04-13T16:20:05","modified_gmt":"2022-04-13T16:20:05","slug":"vaccinating-dogs-against-lyme-disease","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/preventive-medicine\/vaccinating-dogs-against-lyme-disease\/","title":{"rendered":"Vaccinating Dogs Against Lyme Disease: Two Points of View"},"content":{"rendered":"

Despite availability of a consensus statement and up-to-date canine vaccination guidelines<\/a> (see <\/i>Lyme Disease Vaccination Guidelines<\/i><\/b>), the decision whether or not to vaccinate dogs against Lyme disease remains an ongoing debate among many veterinary professionals.<\/i><\/span><\/p>\n

Lyme Disease Vaccination Guidelines<\/div>
2011 AAHA Canine Vaccination Guidelines.<\/strong>\u00a0Welborn LV, DeVries JG, Ford RB, et al. JAAHA.<\/em> 2011;47(5):1-42. Available at aahanet.org\/publicdocuments\/caninevaccineguidelines.pdf<\/a>.<\/p>\n

ACVIM Small Animal Consensus Statement on Lyme Disease in Dogs: Diagnosis, Treatment, and Prevention.<\/strong> Littman MP, Goldstein RE, Labato MA, et al. J Vet Intern Med.<\/em> 2006;20:422-434. Available at cvm.ncsu.edu\/vhc\/documents\/LymeconsstmtACVIM.pdf<\/a>.<\/div><\/div>\n

Today\u2019s Veterinary Practice has gathered 3 experts to discuss this topic\u2014Dr. Meryl Littman and Dr. Richard Goldstein evaluate the benefits and risks of vaccination, while Dr. Richard Ford outlines the current vaccination recommendations.<\/i><\/span><\/p>\n

\n

First, Do No Harm: Lyme Disease Vaccination May Present More Risks Than Benefits<\/h2>\n

Meryl P. Littman, VMD, Diplomate ACVIM<\/b><\/span><\/p>\n

When veterinary clinicians decide whether to recommend a particular vaccine for a particular patient, risks and benefits are weighed. The \u201cvaccinometer\u201d tool, developed by Larry Glickman, was designed to help practitioners determine whether or not to recommend a vaccine.<\/span>1<\/sup><\/span><\/p>\n

As we investigate Lyme disease vaccination, the questions posed by the vaccinometer help highlight many unanswered questions and potential risks related to this vaccine. With these concerns in mind, I choose \u201cfirst do no harm.\u201d In other words, if we use proper tick control, vaccination is unnecessary.<\/span><\/p>\n

Question:<\/b><\/span> What is the prevalence and risk of exposure\/infection in your area (eg, infectiousness)? <\/span><\/p>\n

Answer: <\/b><\/span>Risk of Lyme disease exposure\/infection is high in my area, but proper tick control lowers the risk greatly.<\/span><\/p>\n

The CDC website<\/span>2<\/sup><\/span> shows that 95% of human Lyme disease is found in 12 endemic states in the Northeast, Mid-Atlantic, and Upper Midwest U.S. In some endemic areas, seroprevalence in healthy dogs is as high as 70% to 90%.3<\/sup> In high-risk areas, risk of exposure can be lowered dramatically with adequate tick control, which also decreases the risk for other tick-borne diseases, such as anaplasmosis, babesiosis, bartonellosis, ehrlichiosis, and Rocky Mountain spotted fever.<\/span><\/p>\n

Question:<\/b><\/span> How great is the risk of severe disease once the dog is infected (eg, pathogenicity and virulence)? <\/span><\/p>\n

Answer:<\/b><\/span> Risk of Lyme disease becoming severe is low, but possibly somewhat higher in retriever dogs.<\/span><\/p>\n

Less than 5% of seropositive (and seronegative) dogs had signs attributed to Lyme arthritis,<\/span>3<\/sup><\/span> which generally responds rapidly to antimicrobial therapy. Perhaps 10% to 15% of treated dogs remain non-clinical carriers.<\/span>3<\/sup><\/span> One study showed that 40% of dogs diagnosed with Lyme disease were misdiagnosed and had another condition instead.<\/span>4<\/sup><\/span> Adult beagles experimentally infected with Lyme disease via tick exposure became seropositive but remained nonclinical, and exposed puppies showed only self-limiting signs of arthritis, anorexia, and fever, which did not require treatment.<\/span>3<\/sup><\/span><\/p>\n

Perhaps less than 2% of exposed dogs develop the more serious Lyme nephritis,<\/span>5<\/sup><\/span> an immune-mediated glomerulonephritis, with high Lyme disease-specific antigen\u2013antibody circulating immune complexes (CICs) and deposition in glomeruli, causing protein-losing nephropathy (PLN).<\/span>6<\/sup><\/span> This entity has not been duplicated in any experimental model, and is seen mostly in Labrador and golden retrievers. <\/span><\/p>\n

However, even in seropositive retrievers, Lyme nephritis is uncommon,<\/span>7<\/sup><\/span> and we do not understand why some dogs develop it while many do not, despite their high titers and high CICs. It appears that a genetic predisposition exists, and that inflammation from Lyme antigens, and possibly inflammation from other infectious and inflammatory conditions, may be an environmental trigger. A genetic podocytopathy identified in soft-coated wheaten terriers<\/span>8<\/sup><\/span> may predispose them to further glomerular damage; a similar condition may exist in affected retrievers. <\/span><\/p>\n

In general, coinfections appear to result in more serious illness (eg, anaplasmosis\/Lyme disease), which emphasizes the importance of tick control.<\/span>9<\/sup><\/span><\/p>\n

Question:<\/b><\/span> How effective is the vaccine? <\/span><\/p>\n

Answer: <\/b><\/span>Not as effective as other vaccines we use. <\/span><\/p>\n

Lyme vaccines appear to prevent seroconversion or illness in most (60%\u201386%)<\/span>3<\/sup><\/span> vaccinates, but not consistently in all dogs, and not for a very long duration of immunity, thus annual (or even every 6 months<\/span>10<\/sup><\/span>) boostering has been recommended.<\/span><\/p>\n

Question:<\/b><\/span> How safe is the vaccine?<\/span><\/p>\n

Answer: <\/b><\/span>These vaccines are not as safe as other vaccines we use. <\/span><\/p>\n

In the Banfield study of 1.2 million vaccinated dogs, the Lyme disease vaccine (monovalent bacterin), when used alone, produced more postvaccinal adverse events within 3 days than any other canine vaccine.<\/span>11<\/sup><\/span> Adverse events associated with Lyme disease vaccine were described as \u201cmoderate\u201d by an AVMA council in 2002.<\/span>12<\/sup><\/span><\/p>\n

All canine Lyme disease vaccines contain outer surface protein A (OspA), which attaches the spirochete to the tick\u2019s midgut and is expressed on Borrelia burgdorferi <\/i>while in the tick, and induces anti-OspA antibodies. <\/span><\/p>\n