Download Vaccine Technical Review

abcd
AUGUST |
2010
Vaccine Technical Review
BOEHRINGER INGELHEIM VETMEDICA, INC.
About Dr. Levy
KEY POINTS
Steven A. Levy, VMD is a 1977 graduate of the University
of Pennsylvania, School of Veterinary Medicine. He worked
in small animal veterinary practice in Durham, Connecticut,
and was veterinary surgeon for the Connecticut State Police
Canine Unit. Currently, he is president of Veterinary Clinical and Consulting Services.
A nationally recognized authority on ticks and tick-borne diseases, Dr. Levy has published
many peer-reviewed papers and lectured widely in the U.S. and internationally. He is
a recipient of the AVMA’s Practitioner Research Award and the AAHA’s Outstanding
Regional Practitioner Award.
Test, Treat and Vaccinate Protocol
Preventing clinical Lyme disease in Lyme-positive (infected) dogs
BY STEVEN A. LEVY, VMD
The first canine Lyme
vaccine was introduced in
1990 and demonstrated
safety and efficacy in
preventing Lyme disease.
The first canine Lyme vaccine was introduced to the market in June 1990 at
a time when infection rates with Borrelia burgdorferi were up to 50 percent1 or
more in Lyme-endemic areas. Vast numbers of B. burgdorferi -infected dogs were
safely immunized and efficacy in prevention of episodes of clinical Lyme disease
was demonstrated.
Antibiotic therapy has been
demonstrated effective in
resolving clinical signs in
Lyme-positive dogs.
Dogs presenting to veterinarians for treatment of canine Lyme arthritis may be
successfully treated in 75 2,3 to 85 percent of cases with antibiotics like amoxicillin or
doxycycline. Antibiotic therapy has been demonstrated to kill spirochetes4 and it is likely
this is the mechanism associated with resolution of clinical signs.
Incidence of clinical
disease in dogs appeared
to decrease between 1992
and 1993 due to prevention
of new infections.
In 1992, data were published1 indicating five percent of Lyme-positive dogs developed
clinical signs of Lyme disease each year they were observed. While Lyme arthritis could
often be successfully treated, Lyme nephritis nearly always resulted in the death or
euthanasia of the pet.2,5 Incidence of episodes of Lyme disease in Lyme-positive dogs
receiving Duramune® Lyme™ immunization in a 1993 JAVMA study was two percent.6
It may be hypothesized that this decrease in incidence was due to prevention of new
infection or some unknown in vivo mechanism involving immune surveillance for
spirochetes in the infected dog.
The SNAP 3Dx patientside rapid test for
Lyme infection became
available in 2001.
In 2001, a patient-side rapid test (SNAP 3Dx) became available for the determination
of a dog’s B. burgdorferi infection status.7,8 By 2001, I had been treating acutely ill dogs
with antibiotics for more than 14 years and immunizing clinically normal dogs (of which 50
percent or more were unidentified asymptomatic Lyme-positive) for 11 years. Suddenly,
I was able to immediately determine the infection status of a healthy dog presented for
Footnotes
Levy SA, Magnarelli LA. Relationship between development of antibodies to Borrelia burgdorferi in dogs
and the subsequent development of limb/joint borreliosis. JAVMA. 1992;200(3):344-347.
1
Levy SA, Dreesen DW. Lyme borreliosis in dogs. Canine Pract. 1992;17(2):5-13.
2
Levy SA. Unpublished clinical observations.
3
Philipp MW, Bowers LC, Fawcett PT, et al. Antibody response to IR6, a conserved immunodominant region of
the VlsE lipoprotein, wanes rapidly after antibiotic treatment of Borrelia burgdorferi infection in experimental
animals and humans. L Infect Dis. 2001;184:870-878.
4
Levy SA, Dombach DM, Barthold SW, et al. Canine Lyme borreliosis. Comp CE. 1993;15(6):833-846.
5
Levy SA, Lissman BW, Ficke CM. Performance of a Borrelia burgdorferi bacterin in borreliosis-endemic
areas. JAVMA. 1993;202(11):1834-1838.
6
O’Connor TP, Esty KJ, Hanscom JL, et al. Dogs vaccinated with common Lyme disease vaccines do not
respond to IR6, the conserved immunodominant region of the VlsE surface protein of Borrelia burgdorferi.
Clin Diag Lab Immunol. 2004;11(3):458-462.
7
Levy SA, O’Connor TP, Hanscom JL, et al. Utility of an in-office C6 ELISA test kit for determination of
infection status of dogs naturally exposed to Borrelia burgdorferi. Vet Ther. 2002;3(3):308-315.
8
continued on page 3
4
©2010 Boehringer Ingelheim Vetmedica, Inc.
All products are trademarks or registered trademarks of their manufacturers.
CAN0710030
1
TEST, TREAT, VACCINATE PROTOCOL
Therapeutic Doses of Antibiotics
Asymptomatic Dogs
TEST
TREAT
RECHECK
VACCINATE
PENICILLIN
AMOXICILLIN
DOXYCYCLINE
Asymptomatic
SNAP negative
None
N/A
Give annual booster or two-dose series of
Lyme vaccine if dog has never been immunized
or is previously immunized with OspA-only
recombinant vaccine.
Injectable — doses vary
according to formulation.
See product label.
Administer on day one.
5 – 10 mg/# p.o. bid.
4 mg/# p.o. bid (must be
given with food).
Asymptomatic
SNAP positive
Single infection with
B. burgdorferi with either
amoxicillin or doxycycline
N/A
Give annual booster or two-dose series of Lyme
vaccine if dog has never been immunized or is
previously immunized with OspA-only vaccine.
Coinfection with
B. burgdorferi and
Anaplasma with doxycycline.
Test, Treat and Vaccinate Protocol
Symptomatic Dogs
TEST
TREAT
RECHECK
VACCINATE
Symptomatic
SNAP positive
Penicillin by injection
followed by oral amoxicillin.
Two weeks
after start
of therapy.
If signs have resolved in B. burgdorferi positive dog:
(Acute Lyme patients will
not eat and cannot start on
oral doxycycline until signs
begin to resolve and they
are eating well.)
•
Continue amoxicillin for another two weeks
(28 days total).
•
Give first dose of Lyme vaccine on day of
recheck.
•
Give second dose of Lyme vaccine on day
28 (last day of antibiotic therapy).
If signs have resolved in B. burgdorferi and
Anaplasma coinfected dog:
2
•
Begin 28 day course of therapy with
doxycycline. (Discontinue amoxicillin.)
•
Give first dose of Lyme vaccine on day of
recheck.
•
Give second dose of Lyme vaccine between
day 14 and day 28 of doxycycline therapy.
(continued from page 1)
KEY POINTS
annual immunizations and surveillance testing. The notion of combining antibiotic therapy to
kill spirochetes and immunization to prevent new infection in asymptomatic Lyme-positive
dogs became a working protocol and the basis of a clinical study.
The Test, Treat, Vaccinate (TTV) Protocol simply identifies asymptomatic Lyme-positive dogs
that are then placed on 28 days of antibiotic therapy and immunized during the period of
antibiotic treatment. (See TABLE .)
The TTV Protocol involves
treating infected dogs even
in the absence of clinical
signs, and then vaccinating.
Between 2001 and 2005, I followed 200 dogs on this protocol. Each dog was observed for
signs of Lyme disease. During varying durations in this period, none of the dogs developed
clinical episodes of canine Lyme disease. When contrasted with the five percent incidence in
known infected dogs that receive no intervention and the two percent incidence in infected
dogs receiving only immunization, the combination of antibiotic therapy and immunization was
found to be highly effective to eliminate clinical episodes.
The TTV Protocol was
found to be highly effective
in preventing clinical signs
in infected dogs.
Ideally, all dogs at risk for infection with B. burgdorferi should be immunized before they are
bitten by infected ticks. The reality is many dogs will present to veterinarians for initial Lyme
immunization with asymptomatic infections. The TTV Protocol provides a safe and effective
way to reduce clinical episodes in Lyme-infected dogs.
Though all at-risk dogs
should be vaccinated to
prevent infection, the TTV
Protocol can be safely
used to prevent clinical
signs in infected dogs.
3
TEST, TREAT, VACCINATE PROTOCOL
Therapeutic Doses of Antibiotics
Asymptomatic Dogs
TEST
TREAT
RECHECK
VACCINATE
PENICILLIN
AMOXICILLIN
DOXYCYCLINE
Asymptomatic
SNAP negative
None
N/A
Give annual booster or two-dose series of
Lyme vaccine if dog has never been immunized
or is previously immunized with OspA-only
recombinant vaccine.
Injectable — doses vary
according to formulation.
See product label.
Administer on day one.
5 – 10 mg/# p.o. bid.
4 mg/# p.o. bid (must be
given with food).
Asymptomatic
SNAP positive
Single infection with
B. burgdorferi with either
amoxicillin or doxycycline
N/A
Give annual booster or two-dose series of Lyme
vaccine if dog has never been immunized or is
previously immunized with OspA-only vaccine.
Coinfection with
B. burgdorferi and
Anaplasma with doxycycline.
Test, Treat and Vaccinate Protocol
Symptomatic Dogs
TEST
TREAT
RECHECK
VACCINATE
Symptomatic
SNAP positive
Penicillin by injection
followed by oral amoxicillin.
Two weeks
after start
of therapy.
If signs have resolved in B. burgdorferi positive dog:
(Acute Lyme patients will
not eat and cannot start on
oral doxycycline until signs
begin to resolve and they
are eating well.)
•
Continue amoxicillin for another two weeks
(28 days total).
•
Give first dose of Lyme vaccine on day of
recheck.
•
Give second dose of Lyme vaccine on day
28 (last day of antibiotic therapy).
If signs have resolved in B. burgdorferi and
Anaplasma coinfected dog:
2
•
Begin 28 day course of therapy with
doxycycline. (Discontinue amoxicillin.)
•
Give first dose of Lyme vaccine on day of
recheck.
•
Give second dose of Lyme vaccine between
day 14 and day 28 of doxycycline therapy.
(continued from page 1)
KEY POINTS
annual immunizations and surveillance testing. The notion of combining antibiotic therapy to
kill spirochetes and immunization to prevent new infection in asymptomatic Lyme-positive
dogs became a working protocol and the basis of a clinical study.
The Test, Treat, Vaccinate (TTV) Protocol simply identifies asymptomatic Lyme-positive dogs
that are then placed on 28 days of antibiotic therapy and immunized during the period of
antibiotic treatment. (See TABLE .)
The TTV Protocol involves
treating infected dogs even
in the absence of clinical
signs, and then vaccinating.
Between 2001 and 2005, I followed 200 dogs on this protocol. Each dog was observed for
signs of Lyme disease. During varying durations in this period, none of the dogs developed
clinical episodes of canine Lyme disease. When contrasted with the five percent incidence in
known infected dogs that receive no intervention and the two percent incidence in infected
dogs receiving only immunization, the combination of antibiotic therapy and immunization was
found to be highly effective to eliminate clinical episodes.
The TTV Protocol was
found to be highly effective
in preventing clinical signs
in infected dogs.
Ideally, all dogs at risk for infection with B. burgdorferi should be immunized before they are
bitten by infected ticks. The reality is many dogs will present to veterinarians for initial Lyme
immunization with asymptomatic infections. The TTV Protocol provides a safe and effective
way to reduce clinical episodes in Lyme-infected dogs.
Though all at-risk dogs
should be vaccinated to
prevent infection, the TTV
Protocol can be safely
used to prevent clinical
signs in infected dogs.
3
abcd
AUGUST |
2010
Vaccine Technical Review
BOEHRINGER INGELHEIM VETMEDICA, INC.
About Dr. Levy
KEY POINTS
Steven A. Levy, VMD is a 1977 graduate of the University
of Pennsylvania, School of Veterinary Medicine. He worked
in small animal veterinary practice in Durham, Connecticut,
and was veterinary surgeon for the Connecticut State Police
Canine Unit. Currently, he is president of Veterinary Clinical and Consulting Services.
A nationally recognized authority on ticks and tick-borne diseases, Dr. Levy has published
many peer-reviewed papers and lectured widely in the U.S. and internationally. He is
a recipient of the AVMA’s Practitioner Research Award and the AAHA’s Outstanding
Regional Practitioner Award.
Test, Treat and Vaccinate Protocol
Preventing clinical Lyme disease in Lyme-positive (infected) dogs
BY STEVEN A. LEVY, VMD
The first canine Lyme
vaccine was introduced in
1990 and demonstrated
safety and efficacy in
preventing Lyme disease.
The first canine Lyme vaccine was introduced to the market in June 1990 at
a time when infection rates with Borrelia burgdorferi were up to 50 percent1 or
more in Lyme-endemic areas. Vast numbers of B. burgdorferi -infected dogs were
safely immunized and efficacy in prevention of episodes of clinical Lyme disease
was demonstrated.
Antibiotic therapy has been
demonstrated effective in
resolving clinical signs in
Lyme-positive dogs.
Dogs presenting to veterinarians for treatment of canine Lyme arthritis may be
successfully treated in 75 2,3 to 85 percent of cases with antibiotics like amoxicillin or
doxycycline. Antibiotic therapy has been demonstrated to kill spirochetes4 and it is likely
this is the mechanism associated with resolution of clinical signs.
Incidence of clinical
disease in dogs appeared
to decrease between 1992
and 1993 due to prevention
of new infections.
In 1992, data were published1 indicating five percent of Lyme-positive dogs developed
clinical signs of Lyme disease each year they were observed. While Lyme arthritis could
often be successfully treated, Lyme nephritis nearly always resulted in the death or
euthanasia of the pet.2,5 Incidence of episodes of Lyme disease in Lyme-positive dogs
receiving Duramune® Lyme™ immunization in a 1993 JAVMA study was two percent.6
It may be hypothesized that this decrease in incidence was due to prevention of new
infection or some unknown in vivo mechanism involving immune surveillance for
spirochetes in the infected dog.
The SNAP 3Dx patientside rapid test for
Lyme infection became
available in 2001.
In 2001, a patient-side rapid test (SNAP 3Dx) became available for the determination
of a dog’s B. burgdorferi infection status.7,8 By 2001, I had been treating acutely ill dogs
with antibiotics for more than 14 years and immunizing clinically normal dogs (of which 50
percent or more were unidentified asymptomatic Lyme-positive) for 11 years. Suddenly,
I was able to immediately determine the infection status of a healthy dog presented for
Footnotes
Levy SA, Magnarelli LA. Relationship between development of antibodies to Borrelia burgdorferi in dogs
and the subsequent development of limb/joint borreliosis. JAVMA. 1992;200(3):344-347.
1
Levy SA, Dreesen DW. Lyme borreliosis in dogs. Canine Pract. 1992;17(2):5-13.
2
Levy SA. Unpublished clinical observations.
3
Philipp MW, Bowers LC, Fawcett PT, et al. Antibody response to IR6, a conserved immunodominant region of
the VlsE lipoprotein, wanes rapidly after antibiotic treatment of Borrelia burgdorferi infection in experimental
animals and humans. L Infect Dis. 2001;184:870-878.
4
Levy SA, Dombach DM, Barthold SW, et al. Canine Lyme borreliosis. Comp CE. 1993;15(6):833-846.
5
Levy SA, Lissman BW, Ficke CM. Performance of a Borrelia burgdorferi bacterin in borreliosis-endemic
areas. JAVMA. 1993;202(11):1834-1838.
6
O’Connor TP, Esty KJ, Hanscom JL, et al. Dogs vaccinated with common Lyme disease vaccines do not
respond to IR6, the conserved immunodominant region of the VlsE surface protein of Borrelia burgdorferi.
Clin Diag Lab Immunol. 2004;11(3):458-462.
7
Levy SA, O’Connor TP, Hanscom JL, et al. Utility of an in-office C6 ELISA test kit for determination of
infection status of dogs naturally exposed to Borrelia burgdorferi. Vet Ther. 2002;3(3):308-315.
8
continued on page 3
4
©2010 Boehringer Ingelheim Vetmedica, Inc.
All products are trademarks or registered trademarks of their manufacturers.
CAN0710030
1