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2016. 04. 15.
1
The First Visit to the Veterinarian
dr. Ákos Máthé
Department of Internal Medicine
A golden chance
• To examine the new patient
• To bond a new client to your practice
~ Health examination - congenital defects
~ Vaccination programs
~ (Parasites: flea control and deworming)
~ (Nutritional management)
Health examination
• History
~ For how long has the owner the puppy/kitten?
~ How and where did she/he acquire it?
~ Information about littermates, parents
~ Previous vaccinations, flea control, deworming
~ Patients appetite, any abnormality
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Health examination
• General physical examination
~ Clinical impression: behavior, grooming,nutritional state etc.
~ Rectal temperature
~ Skin, ears, eyes, parasites
~ Lymph nodes, mucous membranes
~ Respiration and circulation
~ Mouth and abdominal palpation
~ Testicles
~ Movement, skeletal deformities
Common congenital problems discovered by physical examination
• Heart murmurs
• Abnormal occlusion
• Problems with dentition
• Umbilical hernia
• Cryptorchidism
Congenital heart murmurs
• „Innocent murmurs”
~ Healthy pups/kittens
~ Left craniodorsal heart base, 1-3 degree
~ Varies with body position
~ Usually disappears at 14-16 weeks of age
• Pathologic murmurs
~ 4-6 degree with precordial thrill (fremitus)
~ Cyanotic mucosae +/-, abnormal pulse +/-
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Most common congenital heart abnormalities
• Patent ductus arteriosus
~ Poodle, collie, German shepherd, Siamese, Persian
• Pulmonic stenosis
~ Beagle, English bulldog, fox terrier
• Subaortic stenosis
~ Newfoundland, boxer, golden retriever
• Atrioventricular valve dysplasia
~ Great Dane
• Persistent right aortic arch(history with regurgitation)
~ German shepherd, Irish settercal.vet.upenn.edu
Abnormal occlusion
• Normal occlusion: lower incisors are just behind upper incisors, mandibular canine occludes in interdental space between lateral upper incisor and maxillar canine
• Prognathic bite (long mandible)
~ Normal in brachycephalic breeds (Bulldogs, Boxers, Persian and Himalayan cats)
~ Mild form: level bite with incisors (excessive wearing)
• Brachygnathic bite (short mandible)
~ Lower canines may occlude at level of upper canine
~ Can cause palatal trauma orthodontic techniques required
• Rostral cross bite
Abnormal occlusion
https://en.wikivet.net
http://veterinarynews.dvm360.com/
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Dentition problems
• Anodontia / Oligodontia
~ Absence of one or more teeth
• Retained deciduous teeth
~ Increased plaque formation periodontal disease
~ Abnormal positioning of permanent teeth
~ Removal necessary as early as possible
~ Yorkshire terriers
• Supernumerary teeth
~ Crowding
www.vetbook.org
www.dentistryforpets.com
http://veterinarynews.dvm360.com/
Umbilical hernia
~ Failure of normal closure of umbilical ring
~ Contains part of the omentum, sometimes intestinal loop
~ Airedale terriers, Pekingese, pointer
~ Usually does not cause health problem
http://www.firehousechihuahuas.com/
Cryptorchidism
• Testicles are not in the scrotum by 8 weeks of age
• Unilateral > bilateral
• Abdominal or inguinal
• Hereditary, probably autosomal recessive
• Poodles, Yorkshire terriers, Chihuahua, Pekingese, Maltese, Persian cats
• In dogs risk of neoplasia in cryptorchidic testicle
• Should be castrated!
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GUIDELINES FOR THE VACCINATION OF DOGS AND CATS• 2007
~ Adopted as national policy in some countries
~ Basis for development of national guidelines
• 2010
~ Updated and expanded version based on surveys and reactions
~ WSAVA recognizes the importance of national guidelines
– Different state of development in countries
– Different animal keeping habits
– Different epidemiological situation
– Different availability of vaccines
– Different legal regulation
• 2016
~ Some recommendations modified
~ New research results, detailed literature
~ Evidence base level included (EB1>>>EB4)
GUIDELINES FOR THE VACCINATION OF DOGS AND CATS
• The Document:~ http://www.wsava.org/sites/default/files/WSAVA%20Vaccination%20Guidelines%202015%20Full%20Version.pdf
~ Vaccination Guidelines Group: – M.J. Day, University of Bristol, UK– M.C. Horzinek, University of Utrecht, the Netherlands– R.D. Schultz, University of Wisconsin-Madison, USA– R.A. Squires, James Cook University, Queensland, Australia
~ 45 pages:– Vaccination guidelines and protocols: 26 pages– Most important vaccines of dogs and cats: 6 pages– 110 FAQ: 13 pages
• Illustrated fact sheets of major canine/feline infections:~ http://www.wsava.org/sites/default/files/WSAVA%20VGG%20Pictorial%20Fact%20Sheets%20June%202015.pdf
• Illustrated guidelines for owners and breeders:~ http://www.wsava.org/sites/default/files/WSAVA%20Owner%20Breeder%20Guidelines%2014%20October%202015%20FINAL.pdf
GUIDELINES FOR THE VACCINATION OF DOGS AND CATS
• Principles, current vaccination issues 2016~ Herd immunity
– Important to control epidemics– 30-50% of dogs and cats are vaccinated in developed countries
~ Reduction of vaccine load on individuals– Adverse reactions
~ „One Health”– Collaboration of human medical and animal healthcare to
control zoonotic infections(i.e. rabies, leishmaniosis)
~ (The veterinarian should obtain informed owner consent if using a vaccine according to the guidelines, but deviating from manufacturer’s recommendations )
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• Infectious vaccines~ Modified Live Virus (MLV)
– Virus replicating, but no disease– Parenteral, intranasal, per oral
~ Recombinant vector vaccines– Vector is not dog/cat pathogenic
~ More effectively inducing immunity, single dose protective• Non-infectious vaccines
~ Killed, inactivated (whole) microorganism~ Subunit vaccines(antigen only)~ Less immunogenic, multiple doses required~ Shorter duration of immunity (DOI), more frequent revaccinations~ Contain adjuvant~ Parenteral
Classification of vaccines
Classification of vaccines
• Mandatory by regulation (in Hungary): ~ Rabies vaccination of dogs
• Core vaccines:~ Prevention of severe infections
with safe and effective vaccines~ Dog:
– Parvoviral enteritis (CPV-2)– Distemper (CDV)– Infectious hepatitis
(CAV-1, Rubarth’s disease)~ Cat:
– Parvoviral panleukopenia (FPV)– Rhinotracheitis (FHV-1)– Feline calicivirus (FCV)
Classification of vaccines
• Non-core vaccines:
– Less severe/frequent diseases
– Less immunogenic vaccines
– Shorter duration of immunity (DOI)
– Increased risk of complications
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Classification of vaccines
~ Individual consideration
– Risk of infection
Outgoing/outdoor cat
Multiple adopted cats together
Animals living in endemic areas
Animals in kennels
Competitions, shows, hunts
– Risk vs. benefit analysis
I.e. earlier allergic reactions
Other possible complications
• Dog:~ Kennel cough~ Leptospirosis~ Lyme-borreliosis~ Influenza (USA)
• Cat:~ (Rabies)~ FeLV~ Chlamydiosis~ FIV (USA)
• Non-core vaccines:
Classification of vaccines
• Not recommended vaccines:
~ Dog:
– Coronaviral enteritis: rare prevalence of confirmed cases
~ Cat:
– FIP: efficacy doubtful, only to FCoV cats >16 weeks
• No statement in the guidelines:
~ Babesia vaccines of dogs
~ Herpesvirus vaccine of dogs
~ Leishmania vaccine of dogs
~ Ringworm (Microsporum canis) vaccine
Suggested vaccination protocol
• Core vaccines:
~ MLV is preferred
~ Basic immunization of puppies and kittens:
– From 6-8 weeks of age
– 3-4 injections with 2-4 weeks interval
– Last injection at ≥16 weeks of age
– „Security” vaccine 6(-12) months of age
~ Basic immunization for animals older than 16 weeks:
– 1 injection (or 2 with 2-4 weeks interval)
~ Revaccination: every 3 years after basic immunization
~ Revaccination for cat flu: yearly in outdoor cats
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Suggested core vaccination program
Suggested vaccination protocol
• Non-core vaccines:
~ Basic immunization: generally 2 injections
~ Generally ≥8 weeks of age
~ Lyme vaccination ≥12 weeks of age
~ Leptospirosis
– Tetravalent vaccine is suggested in Europe:canicola, icterohaemorrhagiae, grippotyphosa, australis
~ FeLV testing is suggested prior to vaccination
~ Booster vaccinations:
– Generally yearly
– FeLV: 1 year following basic immunizations, then every 2-3 years
– Rabies in cats: every 1-3 years, depending on vaccine
Vaccination protocol in shelters
• Active immunization is preferred
~ Before infection: preventive
~ Post infection: milder symptoms
~ Cheaper, more effective than passive immunization
• Core vaccines are most important!
~ Puppy/kitten:
– At arrival, then every 2 weeks until 20 weeks of age
– ≥(4-)6 weeks of age
~ >16 weeks: at arrival, repeat after 2 weeks
~ (If possible: parainfluenza is suggested)
~ (If possible: intranasal Bordetella is suggested)
• Rabies: at discharge from shelter!
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Vaccination – general considerations
~ Only vaccinate animals in good health
~ Puppy/kitten should be kept isolated (?) until basic vaccinations are completed, and have taken effect!
~ Use multivalent vaccines,rather than combine vaccines yourself
~ Only mix vaccine components if suggested by the manufacturer
~ Immunization of FeLV/FIV positive cats
– Clinically healthy individuals can be injected with killed core vaccines
– Should not be vaccinated for FeLV
Causes of vaccination failure~ Colostral antibody interference
~ Incubating disease at time of vaccination Acquiring infection shortly after vaccination
~ Weak immunogenity of vaccine
~ Improper vaccine handling, storage
– Do not disinfect the skin before MLV immunization!
– Expiry, storage, cooling
– Dilution immediately before administration
~ Passive immunization within a month
~ Weak responders in certain breeds:
– Ie. Doberman pinscher, Rottweiler
~ Immune deficiency/suppression
• It is possible to control efficacy of vaccination:
~ Antibody test ≥4 weeks after last immunization: parvovirus (dog and cat), adenovirus and distemper virus
Checking the efficacy of puppy vaccinations
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Adverse reactions to vaccinations• Fever, lethargy• Allergic reactions
~ Killed bacterins are the most common allergens:Leptospira, Bordetella, Borrelia, Chlamydophila
~ Toy breeds are predisposed~ Next time give different brand (BSA, other adjuvant)
• Abortion, congenital malformation~ Do not vaccinate pregnant animals, if possible~ If necessary: killed or subunit vaccines
• Clinical disease caused by MLV vaccine~ Parenteral ≠ intranasal~ Droplets of parenteral cat vaccine licked off by the animal
• Autoimmune disease~ Immunohemolytic anemia~ Autoimmune thrombocytopenia~ Glomerulonephritis
Adverse reactions to vaccinations• Local reactions
~ Usually killed, adjuvanted vaccines~ Dog: granuloma, seroma~ Cat: FISS
– Occurrence: 1/5000 - 1/12500– USA, since 1997
‘Left leg leukemia, right leg rabies’ Interscapular FISS , right hind leg FISS
– Current suggestion:Lateral abdominal wall SC (or distal tail)Change and register application site
GUIDELINES FOR THE VACCINATION OF DOGS AND CATS
• 2016” We should aim to vaccinate every animal with core vaccines.Non-core vaccines should be given no more frequently than is deemed necessary”
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GUIDELINES FOR THE VACCINATION OF DOGS AND CATS
• 2010”We should aim to vaccinate every animal with core vaccines,
and to vaccinate each individual less frequently
by only giving non-core vaccines that are necessary for that animal.”
GUIDELINES FOR THE VACCINATION OF DOGS AND CATS
• Most important changes (2010 2016)~ Last injection of puppy/kitten series ≥16 weeks of age~ „Security” combine vaccination: 6(-12) months of age~ „Security”/booster vaccination necessary? serology~ (FIV vaccine promoted to non-core)
Change of concept
• Vet communication owner
• ANNUAL HEALTH CHECK (+ vaccination)
~ Physical examination
~ Parasite control
~ Dental examination and care
~ Body weight control and nutritional management
~ Old pet – screening examinations:
– Blood/urine laboratory tests
– Abdominal US
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Potential problems
• Income of vets
• Socialization of puppies, education to room cleanness
~ Contact only with healthy, vaccinated animals
~ Puppy „classes”?
– Areas not visited by other dogs, closed gardens
• Reconsidering vaccination programs
~ Vaccine stocks might have to be updated
~ Do we have vaccines for every situation?
• ???
Vaccination against babesiosis
• New vaccine:
~ Combination of 2 strains: B. canis & B. rossi
~ Contains soluble parasite antigens (SPA)
~ Partial protection against European B. canis
– Does not prevent the infection
– Mild or absent clinical signs
~ Do not shake the reconstituted vaccine
~ For dogs over 6 months
~ Two vaccinations are suggested yearly
~ Local reactions are possible
Microsporum canis vaccine
• Killed vaccine
• Can be used as part of treatment
• Three times with 3 weeks intervals
• Only IM to dogs, IM or SC to cats
• Local reactions
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Thank you for your attention !
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