The First Visit to the Veterinarian• Abnormal occlusion • Problems with dentition • Umbilical hernia • Cryptorchidism Congenital heart murmurs • „Innocent murmurs” ~

2016. 04. 15.

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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


• 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


• 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)


• Non-core vaccines:

– Less severe/frequent diseases

– Less immunogenic vaccines

– Shorter duration of immunity (DOI)

– Increased risk of complications

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~ 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)



• 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


~ 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


• 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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• 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.”


• 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 !

Documents

The First Visit to the Veterinarian• Abnormal occlusion • Problems with dentition • Umbilical hernia • Cryptorchidism Congenital heart murmurs • „Innocent murmurs” ~