American Animal Hospital Association (AAHA) 2017 Canine Vaccination Guidelines

In previous discussions of vaccination recommendations, I have referenced several clinical guidelines that review the existing evidence and provide recommendations for vaccination. The American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) guidelines are quite extensive and useful documents in making decisions about vaccination. AAHA guidelines are, unfortunately, usually prepared by small groups of experts with little transparency, and they are not always a model of evidence-based guideline development (for a great model, see the RECOVER guidelines for small animal CPR). That said, the vaccination guidelines do a good job of summarizing the complex and sometimes contradictory evidence and making reasonable recommendations.

AAHA has update the canine vaccination guidelines, and has presented them in a new form. The 2017 AAHA Canine Vaccination Guidelines are now primarily an online document divided into sections that make finding the answer to specific vaccination questions quite easy. In terms of providing a summary of existing vaccine science and giving a general overview of the issues, the web-based format is clunky and harder to use than a traditional journal article. But in terms of giving direct answers to questions vets and dog owners typically have about when and how to use specific vaccines, the format works well.

The new guidelines also add detail to subjects only lightly discussed in the previous version, including the use of antibody titers to guide vaccination and how to handle animals with uncertain vaccine histories or overdue for boosters of vaccines given previously.

There is nothing revolutionary or earth-shattering in the new guidelines, and they will undoubtedly not satisfy the concerns of those with deep anxieties or objections to routine vaccination practices. The recommendations are very similar to previous versions, and there will be few changes for those of us who have been following these guidelines in the past. Thorny questions like how often, or if, boosters of core vaccines should be given are not always directly answered.

The previous guidelines summarized the evidence that, for example, vaccination for canine parvovirus (CPV) and canine distemper (CDV) should provide immunity for a minimum of three years and likely protects most dogs for at least 5-7 years and possibly longer (when given properly as a series to puppies with a booster at about one year). The currently guidelines recommend intervals for these vaccines of “three years or longer”, which leaves the exact interval to the discretion of vets in practice. This makes sense in many ways, since the risks and benefits of vaccination for individual animals depends on exposure risk, lifestyle, health, medical treatment, and many other variables. Ultimately, there is no single right answer for every dog.

Unfortunately, it is easier for most vets to choose an arbitrary recommendation to make for all their patients. Right now, many choose three year intervals for these vaccinations because that number was specifically suggested in the AAHA guidelines. When I have suggested longer intervals might be appropriate, many of my colleagues are understandably wary of deviating from what all the major veterinary schools and most other practices are doing for fear of being blamed for any failure of protection that might occur. And, of course, none of this will satisfy those who think little or no vaccination is necessary at all.

Despite the inevitable compromises and limitations in the evidence, however, the AAHA guidelines are an excellent resource for vets and dog owners wishing to make rational, science-based decisions about how best to protect dogs from vaccine-preventable disease.

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22 Responses to American Animal Hospital Association (AAHA) 2017 Canine Vaccination Guidelines

  1. art malernee dvm says:

    Revaccination Recommendations
    The new labels will no longer carry a routine, default recommendation for annual revaccination. Revaccination statements on the new labels will be based upon data. Where there is not data indicating a specific revaccination interval, the label will carry a statement to indicate that a revaccination interval has not been established and a veterinarian should be consulted.
    1 Single Label Claims for Veterinary Biologic Products, 80 Fed. Reg. 39669 (2015)
    2 Packaging and Labeling, 81 Fed. Reg. 59427 (2016)>>>>>>
    Nice to see the federal government no longer is going to default to pet vaccine health fraud labels.
    Maybe the required by law CE pet vaccine speakers will stop telling vets they need to vaccinate annually for something if there are no labels on the vaccine bottles recommending we do so.

  2. art malernee dvm says:

    “There is no known value in administering the IN vaccine bi-annually (every 6 mo).”>>>

    I think this quote is a giggle. Maybe AAHA will tell us the known value in administering the IN vaccine annually in their next aaha vaccine guideline up date.

  3. Erika B says:

    Some recommendations for cats?
    My cats don’t go out so until now they are pretty healthy.

  4. art malernee dvm says:

    B bronchiseptica risk should be reassessed for all cats annually and the vaccine administered, if deemed necessary.>>>>>>

    Why not do a “deem necessary” and vaccinate reassesment every 6 months? How often is a vaccine risk assessment needed in human medicine?

  5. Charlie's mum says:

    Would you recommend CAV-1 vaccine or CAV-2 as part of the core? Also, for a 1.5-year-old Bichon that did not receive any vaccines as a pup, would he need 1 shot or a series of shots? Thank you!

  6. skeptvet says:

    I do recommend CAV-2 as a core vaccine, in accordance with the latest guidelines. CAV-1 is not generally used in vaccines as it has a higher risk of adverse events, and CAV-2 will provide protective immunity against CAV-1.

    As for the number of vaccinations needed if no initial series was given, it will depend on the type of vaccine and the risk of exposure for the individual dog. generally, modified live vaccines provide adeqaete immunity with one vaccination, whereas killed vaccines require a series, though there are exceptions (e.g. rabies, which is a killed vaccine that provides sufficient immunity after one vaccination). You will need to discuss the details of your pet’s needs with your veterinarian.

  7. Charlie's mum says:

    Thank you for your response!

  8. Brian Cullen says:

    The one question asked a lot about vaccinations is why do pets need boosters but we humans dont ? a science based answer to this would be great .

  9. art malernee dvm says:

    fully immunized humans get some boosters

  10. art malernee dvm says:

    From this website it looks like tetanus can last your life time but the government wants you to get a booster every 10 years. I am not sure if the government has good prospective randomized trials to support the tetanus booster every 10 years. The government may be promoting preventative care with no RCT to support by using the parachute argument you do not need a good randomized controlled trial for everything.

  11. art malernee dvm says:

    in case you do not want to read the entire page here is the part i referred to.

    “Efficacy of the toxoid has never been studied in a vaccine trial. It can be inferred from protective antitoxin levels that a complete tetanus toxoid series has a clinical efficacy of virtually 100%; cases of tetanus occurring in fully immunized persons whose last dose was within the last 10 years are extremely rare.
    Antitoxin levels decrease with time. While some persons may be protected for life, by 10 years after the last dose, most persons have antitoxin levels that only approach the minimal protective level. As a result, routine boosters are recommended every 10 years.”

  12. Brian Cullen says:

    Thank you , in the dog world the anti vaxers are using the idea the humans get vaccinated as children , and never again , but dogs need regular boosters .

  13. art malernee dvm says:

    but dogs need regular boosters>>>> only if you accept the argument you do not need a good randomized controlled trial for every traditional medical practice promoted in the market place. I would like to see pet vaccine makers be made to prove regular boosters are needed before the USDA allows the manufactures to put a give every year label on the vaccine label.

  14. skeptvet says:

    A couple of points:
    1. It is not true that humans don’t need boosters. Here are the CDC recommendations for vaccination in adults. The duration of immunity depends on the disease, the vaccine, and the patient. Humans get influenza annually, due to changes in the virus. Tetanus is every 10 years. Rabies for people with significant exposure risk is determined by titers. 1-2 doses of the MMR after 18 years of age is not recommended since it has been shown that childhood immunization is not always lifelong. There are plenty of other examples.

    2. The need for boosters in animals also depends on the disease, the vaccine, and the individual. Often, unfortunately, we have less data that exists for humans to help determine the duration of immunity since public health agencies don’t make a point of studying this over decades the way they do for people. Many core vaccines were initially tested only for 1 year duration, so boosters were given annually. AAHA now recommends boosters anywhere from annually to every 7 years, depending on the vaccine and the strength of the data available for determining duration of immunity. So the interval for boosters is always changing as we gather more evidence.

    We have to be careful about oversimplifying issues around vaccination and ignoring the important differences between various vaccines and diseases. We also have to recognize that adverse effects of vaccines are not as serious or common as often claimed, and when balancing these against the benefits and the risk of not vaccinating often enough, we must frequently make decisions with imperfect information. As long as we continue to study these questons and update our practices as justified by the evidence, this is how medicine should work.

  15. skeptvet says:

    The article you quote, Art, states that surveys of antitoxin levels suggest most people are approaching the borderline between protective and non-protective levels by 10 years, and some may be unprotected before 10 years. This is not an RCT, but it is a rational strategy for deciding when to give the vaccine. There are plenty of reasons why an RCT isn’t going to be done on this subject, primary among them the fact that it would be unethical to expose people to challenge testing and deliberately give them tetanus to determine the protective fraction at particular time points, which is how such a trial typically works in animals. RCTs are the best type of evidence in many cases, but they are not appropriate for everything, and we can’t just ignore every other kind of evidence when RCTs don’t exist or cannot properly be done.

    “While some persons may be protected for life, by 10 years after the last dose, most persons have antitoxin levels that only approach the minimal protective level. As a result, routine boosters are recommended every 10 years. In a small percentage of individuals, antitoxin levels fall below the minimal protective level before 10 years have elapsed.”

  16. Fei says:

    What would be your recommendation for the leptospirosis vaccine, for a dog who might be exposed to it? Is there evidence that annual boosters are necessary, as indicated in the AAHA guidelines?

  17. skeptvet says:

    If there is a risk of exposure, then the vaccine has been shown to be effective and has minimal risk, so I would recommend it. There is strong evidence of protection at one year. We know that antibody levels are often very low after 1 year, but we also know that antibody levels are not a reliable guide to immunity for this disease (1). The duration of immunity is not consistent or predictable with this disease beyond one year, so I would recommend following the guidelines in boosting annually if there is a risk of exposure.

  18. art malernee dvm says:

    lepto vaccine DOI promoted is all over the place both in human and vet medicine. This should be a red flag that we may not know if the vaccine really works. We were told in the old days to vaccinate for lepto every six months. Would vaccinating every three months or every three years for lepto be a better idea?
    There are just a few countries that have human lepto vaccines. The only prospective randomized field study I can remember seeing was out of cuba. The human lepto vaccine was compared to a homeopathic vaccine. Water in a bottle worked just as well as the human cuban lepto vaccine in the study.
    Lepto bacteria grown in the lab express different antigenic cell membrane proteins than those lepto cell membranes expressed in natural infections.(see below) It is important that we know if lepto vaccine efficacy shown in USDA trials results because of antibodies produced as a result of exposure to surface antigens that are expressed in cultured lepto but not lepto organisms producing natural clinical disease. Lepto vaccine needs to be proven therapy for host derived organisms since our patients are not going to even be exposed to cultivated lepto. There are no FDA approved human lepto vaccinations and no evidence that I am aware of that any lepto vaccination is efficacious against host derived organsisms. I suspect all we may be doing is vaccinating our patients to protect against a lab created antigen and convinced our clients to beleive their pets were protected agaist host derived lepto organisms.
    Review Article

    Spirochaetal lipoproteins and pathogenesis
    David A. Haake1

    Changes in lipoprotein expression have also been found to occur in Leptospira species. Immunohistochemistry was used to evaluate whether lipoproteins expressed by cultivated Leptospira species were also expressed during infection. These experiments took advantage of the fact that in kidneys of infected animals, pathogenic Leptospira species are found in high numbers within proximal renal tubules. Experiments revealed expression of a number of membrane antigens, including leptospiral LPS, the OmpL1 porin and the lipoproteins LipL32 and LipL41 (Barnett et al., 1999 ; Haake et al., 2000 ). However, a third lipoprotein, LipL36, which is expressed at high levels in cultivated organisms, was undetectable by immunohistochemistry (Barnett et al., 1999 ). These observations were validated by examination of the antibody response in animals experimentally infected with host-derived organisms (Barnett et al., 1999 ). Research is ongoing in our laboratory to determine the signals that regulate differential expression of LipL36.

  19. skeptvet says:

    The theoretical argument that vaccines may not be effective because of differences in expression of surface proteins byt the bacterium during infection and during cultivation is a pretty weak argument considering the significant decline in canine leptospirosis cases seen when vaccines with relevant serovars are introduced into previously unvaccinated populations. The vaccines have worked to reduce natural infection, and while we cannot predict duration of immunity very well based on antibody titers, that is a long way from saying we don’t know if the vaccines are effective or not. Challenge studies are strong evidence, and they are consistent with the epidemiologic evidence, so it is far more likely that the vaccines are effective when they contain the locally relevant serovars.

  20. art malernee dvm says:

    Its been over ten years so the Cochrane Controlled Clinical Trials Database may have been updated but its behind a paywall now. There are about 250 listed pathogenic lepto serovars identified so far and I think about 10 more serovars every year. The serovars in the lepto vaccines do not cross protect. I suspect for a lepto vaccine to possibly work you would need to reformulate it yearly like human flu vaccine depending what lepto seravar was circulating around the world or better yet your local community at the time. A flu vaccine for humans is not going to work if you pick 4 influenza virus that may have been a problem twenty years ago and booster that every year. Bottom line from the systemic review below “Any interventions for leptospirosis, such as prevention and treatment remains unclear for guidelines and practice.” I even have a systemic review somewhere from years ago that penicillin may cause more harm than good for lepto treatment. I will post that if I can find it.

    Guidugli F, Castro AA, Atallah AN
    Federal University of Sao Paulo, SP, Brazil.
    [Medline record in process]
    OBJECTIVES: To find the existing clinical evidence on interventions for leptospirosis. The objective is to evaluate the effectiveness and safety of any intervention on leptospirosis through systematic reviews of randomized controlled trials (RCTs). DATA SOURCE: The sources of studies used (where there were no limitations concerning language, date, or other restrictions) were: EMBASE, LILACS, MEDLINE, the Cochrane Controlled Clinical Trials Database, and the Cochrane Hepato-Biliary Group Randomized Trials register. SELECTION OF STUDIES: Type of Study: All systematic reviews of randomized controlled trials. Participants: patients with clinical and/or laboratorial diagnosis of leptospirosis, and subjects potencially exposed to leptospirosis as defined by the authors Interventions: any intervention for leptospirosis (as antibiotics or vaccines for prevention or treatment). DATA COLLECTION: The assessment will be independently made by the reviewers and cross-checked. The external validity was assessed by analysis of: studies, interventions, and outcomes. DATA SYNTHESIS: Located 163 studies using the search strategy described above, at the electronic databases above. Only 2 hits were selected, which are protocols of systematic reviews of Cochrane Collaboration, and not full reviews. One of the protocols evaluates antibiotics for treatment, and the other evaluates antibiotics for prevention of leptospirosis. CONCLUSIONS: There were not complete systematic reviews on interventions for leptospirosis. Any interventions for leptospirosis, such as prevention and treatment remains unclear for guidelines and practice.

  21. art malernee dvm says:

    I remembered it wrong. the evidence below “suggest” that penicillin “may” cause more good than harm. Not sure about injections of Penicillin/streptomycin we used in vet school. At least the injections reduced the lepto count in the urine.
    Antibiotics for treating leptospirosis
    Guidugli F, Castro AA, Atallah AN Guidugli F, Castro AA, Atallah AN. Antibiotics for treating leptospirosis (Cochrane Review). In: The Cochrane Library, Issue 2, 2000. Oxford: Update Software., ,
    ISBN: 1464-780X

    This is a regularly updated Cochrane review. Please contact the author of the review using the contact details provided if you have comments or criticisms.The complete review is available in The Cochrane Library. For information on The Cochrane Library, contact Update Software Ltd, Summertown Pavilion, Middle Way, Summertown, Oxford OX2 7LG, England. Tel: +44 1865 513902, Fax: +44 1865 516918, Email:

    Author’s objective
    Leptospirosis is a parasitic disease transmitted by animals. Severe leptospirosis may result in hospitalisation and about five per cent of the patients die. In clinical practice, penicillin is widely used for treating leptospirosis.

    To evaluate the effectiveness and safety of antibiotics versus placebo or other antibiotic regimens in treating leptospirosis. We addressed the following clinical questions: a) Are treatment regimens with antibiotics more efficient than placebo for leptospirosis? b) Are treatment regimens with antibiotics safe when compared to placebo for leptospirosis? c) Which antibiotic regimen is the most efficient and safest in treating leptospirosis?
    Search strategy:
    Electronic searches and searches of the identified articles were combined.
    Selection criteria:
    STUDIES: Randomised clinical trials in which antibiotics were used as treatment for leptospirosis. Language, date, or other restrictions were not applied. PARTICIPANTS: Patients with clinical manifestations of leptospirosis. INTERVENTIONS: Any antibiotic regimen compared with a control group (placeboor another antibiotic regimen).
    Data collection and analysis:
    Data and methodological quality of each trial were independently extracted and assessed by two reviewers. The random effects model was used irrespective of significant statistical heterogeneity.
    Main results:
    Three trials met inclusion criteria. Allocation concealment and double blind methods were not clearly described in two. Of the patients enrolled, 75 were treated with placebo and 75 with antibiotics: 61 (81.3%) penicillin and 14 (18.6%) doxycycline. The patients assigned to antibiotics compared to placebo showed: a) Mortality: 1% (1/75) versus 4% (3/75); risk difference -2%, 95% confidence interval -8% to 4%. b) Duration of hospital stay (days): weighted mean difference 0.30, 95% confidence interval -1.26 to 1.86. c) Prolonged hospital stay (> seven days): 30% (7/23) versus 74% (14/19); risk difference -43%, 95% confidence interval -70% to -16%. Number needed-to-treat 3, 95% confidence interval 2 to 7. d) Period of disappearance of fever (days): weighted mean difference -4.04, 95% confidence interval -8.65 to 0.58. e) Leptospiruria: 5% (4/75) versus 40% (30/75); risk difference -46%, 95% confidence interval -88% to -3%. Number needed-to-treat 2, 95% confidence interval 1 to 33.
    Reviewer’s conclusions:
    Antibiotic regimens for treatment of leptospirosis is a form of care for which the evidence is insufficient to provide clear guidelines for practice. The randomised trials suggest that antibiotics could be a useful treatment for leptospirosis. Because of the questionable quality of two of the three trials, the indication for general use of antibiotics is uncertain. However, the evidence suggest that penicillin may cause more good than harm.

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