Veterinarians!
Why You Should Encourage Your Clients to Request
Titer Testing for Their Pets
and How to Do It!
When the phenomenon of titer testing emerged, many veterinarians were concerned that their “bread and butter” vaccine income would diminish. Veterinarians, often resistant to change, were fearful to implement a new program about which they had no training. For the veterinarians who embraced this integrative approach, many rewards have been reaped! New clients flock to veterinarians who encourage titer testing and do not push excessive vaccinating!
What is a Titer?
The first step toward implementation of an effective titer testing program in your facility is to develop an understanding of what a titer is and to be able to explain this to your staff and clients in easy to understand terminology. The concepts of titer testing, core vaccines and over vaccinating go hand in hand. Realize that today’s internet savvy clients already have some awareness of these topics and expect their pet’s veterinarian to provide them with current information and options. Pet parents deserve to be told the benefits and risks of a given vaccination so that they might be able to make a decision based on informed consent. For example, vaccine inserts begin with the statement, “Vaccinate only healthy animals”. This allows for interpretation by the doctor, what is healthy?
A Visit is Not for a Shot!
Pet parents bring a patient to a veterinarian annually for a wellness examination for help in the determination of what can be done to best preserve their pet’s health. It will increase a veterinarian’s credibility with his client if he explains that vaccine inserts say, “Vaccines may produce anaphylaxis and/or inflammatory, immune-mediated hypersensitivity reactions…Tissue–origin vaccines contain extraneous protein that can lead to autoimmune disease... a vaccine may induce the development of injection-site fibrosarcomas (in cats).” It is better to possess this awareness and relay this to the client, rather than have the client question a doctor’s motives of vaccine administration or lack of awareness of risks of vaccination.
A practice can build a great reputation in a community by becoming known as the practice that puts the pet’s best interests ahead of the desire to sell a vaccine.
Of course, the doctor and the pet parent want to know that the patient will be protected if exposed to a serious disease; to reassure both parties, the veterinarian can offer titer testing to the client. Explain that a titer test involves a simple blood draw. A titer measures the level of protective antibody which has been produced in the patient in response to previous vaccinations. Most pets who have been vaccinated will have very high levels, but a few will be poor or non-responders. This means that despite appropriate vaccination procedures, the pet has NOT mounted a protective immune response. Some pet guardians are shocked at the idea that a vaccinated pet is potentially unprotected! They feel that they could have been wasting money on vaccines and taking a potential risk with their pet’s well-being. With this understanding, they are more than receptive to the performance of a titer test on their pet’s blood sample.
Involve your staff in the understanding and “selling’ of titer testing. Similarly, include them in the recording and reporting of results. The pricing and reporting of titer testing will vary with the laboratory test station or in-clinic kit selected.
Begin by explaining to your staff that titer is correctly spelled titre or titer. It is pronounced tight-er. It is a blood test which measures the immune response to an antigen exposure. The number measured is an antibody level present at different titration or dilution levels of the blood. The antigen that the body has been exposed to in order to stimulate the immune response could have been present in a vaccination or the disease itself. If antibody levels are present in highly diluted blood, then that’s a high titre. A high titre level may indicate lots of exposure, lots of protection or perhaps even long-lasting immunity. The titre level is one indicator of the body’s immune response to an antigenic stimulation.
Immunity
It is useful for your veterinary technicians to understand that the titre measures antibody levels in the blood which is part of the body’s humoral defense system. In addition to this protection, our body has a cellular defense. This is at the mucous lining level. A body can stop an offending antigen as it enters your nasal passage or mouth for example before it enters the bloodstream. This protection is NOT measured by a titre. So, if a pet has a low titre, this may increase his susceptibility to disease, but his cellular immunity could still afford him all the necessary protection.
Within the humoral defense are two levels: sterilizing immunity and memory immunity. If a pet has a high number of antibodies in the blood, it may be a sterilizing level. This means if he is exposed to the disease his body will neutralize it so easily, you won’t even know he was exposed! If a pet has a low level of antibodies in the blood, it may be a memory level. This means if he is exposed to the disease he may become somewhat ill, but will “remember” and fight and overcome the disease.
Clients love to quiz staff. They often seek additional details from them. They will be impressed with your staff’s knowledge. Your well-informed receptionists and technicians will be proud of themselves and anxious to share their knowledge with passionate pet parents. Empowering your staff with these details will allow them to effectively assist you with proper scheduling of titre test appointments. Your staff’s ability to understand and explain these concepts to a client will allow them to accurately report results so that you don’t have to!
Following is an example of a core vaccine and titre testing program:
Ideally, puppies are vaccinated with distemper/hepatitis/parainfluenza/parvo at 8 and 12 weeks. Do an in clinic titre at 16 to 20 weeks for rapid results. It measures only distemper and parvo. If it is positive for both then this means there is a sterilizing level of protection. (A rabies vaccine may be administered at this visit. ) If one or the other is negative there could still be adequate memory or even cellular immunity, however in a puppy who has not been “over-vaccinated”, who has not had any reaction, and who could have had mother’s antibody present at time of prior vaccination, blocking the effectiveness of the vaccine, the pup should receive a booster with whichever individual vaccine is needed. (If given, then post pone the rabies vaccine. Only give one vaccination at a time.)
Keep in mind some breeds (Dobermans, Rottweilers, Black Labs and German Shepherds) have a common longer length of mother's antibody presence and interference with testing, so a titer should be done at the later age for them, 18 to 20 weeks.
It is of notable interest that in hundreds of puppies/dogs on whom were performed hepatitis/adenovirus titre testing not one was unprotected. Therefore it is not necessary to test for this antibody level.
At the dog’s annual wellness exam a “send out” titre test is performed for distemper and parvo, which delivers actual number results. This generally takes two weeks. There are several U.S. universities which offer this testing. These labs report “adequate” levels based on sterilizing immunity levels. Therefore, lower or “inadequate” levels may reflect adequate memory immunity.
Specific canine titre parameters are as follows:
Michigan State University reports as protective:
CDV≥ 32 CPV≥ 80
(Distemper) (Parvo)
These levels are roughly equivalent to sterilizing immunity.
A lot of research has been performed on dog and cat serum to establish what antibody titre levels are protective against distemper/parvo and distemper/rhino/calici respectively.
Dr. Ron Schultz at the University of Wisconsin-Madison VMTH has explained that his research shows:
CDV≥ 4 CPV≥ 20
These levels are roughly equivalent to memory levels of immunity.
Specific feline titre parameters are as follows:
Michigan State:
CIV≥ 32 FVR≥ 16 FPV≥ 40
(Calici) (Herpes/Rhino) (Distemper/Panleukopenia)
Dr. Schultz:
CIV≥ 4 FVR≥ 2 FPV≥ 8
If a pet has a high titre, he does not need to be vaccinated with that antigen. If he has a low titre, despite a history of lots of exposure to that antigen, then another vaccination is not going to boost him any further. In fact, repeating an unnecessary or ineffective vaccination could be harmful.
A decision to boost should be based on the pet’s age, lifestyle, other disorders present, previous number of vaccines, and the guardian’s concerns about vaccine reactions. A technician calls the owner to report the results and your recommendation.
What is the predictive value of titer testing?
As it pertains to distemper/parvo, the most a titer drops in one year is in half. So depending on how high it starts, a doctor can predict how long it will remain at a protective level. Some dogs are checked annually to satisfy a kennel requirement, others are NOT checked NOR vaccinated for several years and then when re-checked have still been found to have protective levels. Obviously, this saves the pet a lot of vaccine-associated risks and the client a lot of money. Sometimes a new client whose pet has been vaccinated annually for many years receives his first titer test when older. Despite all that vaccine, we determine he’s a low responder! This tells us to stop vaccinating! The client has been wasting money and taking an unnecessary risk with his pet’s immune health. That pet needs to be careful where he goes, what he sniffs, and what he eats (i.e. other dog poo). This individual level of doctor concern and consultation is the best for the patient, cements the veterinary- client relationship and is a great practice builder!
Rabies Titer?
Similarly, a pet’s blood can be sent to a lab, specifically Kansas State 6 weeks or one year after a rabies vaccination has been given to see if that pet has mounted an immune response, in other words, what is that pet’s rabies titre level?
European research and new, soon to be published US research does exist to assert what titre levels are protective against the rabies virus. Years ago, challenge studies based on time interval since last vaccination were performed for rabies. This is what dictates the 1-year initial, 3-year booster rule required in most states. A recently completed study has proven that the 3-year rabies vaccine actually protects for 7 years. Additionally, this same work has shown that any measurable titer level will protect against a rabies challenge. This fact is still not accepted by state legislatures where vaccination is still required in order to obtain a local dog license. (https://media.wix.com/ugd/03057b_de9e1423513d4c338f9229b077510801.pdf)
This rule is archaic and unsafe. Some dogs are non- responders, meaning that vaccination does NOT provide protection. Owners of these dogs are misled to believe that because their pet has been vaccinated it is protected. False! A simple titer test will demonstrate that these dogs are unprotected. Why assume a non-responder is protected when all you have to do is a titer test to check? Why re-vaccinate many times in a pet’s lifetime when a simple titer test will tell you if an additional booster is needed or not?!
Some states allow for an exemption from rabies with a valid veterinary waiver. A client with a pet who has had a previous reaction, or who is afflicted with cancer or other chronic disorder, is going to appreciate a veterinarian who discourages the vaccination of an unhealthy patient.
Rabies Titers and Waivers
Concerned pet parents across the country are joining forces, educating themselves and others, and signing petitions to encourage legislators to update outdated rabies laws and to be consistent with today’s science. We owe a world of debt to Dr. Ron Schultz, renown immunologist and canine friend who was a chief investigator in the research provided by the Rabies Challenge Fund. We now have the science-based evidence to provide legislators with the facts to update the archaic legislation that puts our pets and society at risk. Veterinarians should be leading this movement to do what is right, scientific and safe for the well-being of our pets and communities.Will you join us and encourage all types of titer testing in your practice?
More great info from Dr. Jodie at www.DrJodiesNaturalPets.com
Other Resources: http://www.dogsnaturallymagazine.com/lifelong-immunity-vets/