New Delaware Rabies Law Undermines the Safety of Pets and the Public

Over the years, one of the most common subjects I have discussed on this blog is vaccination, including their risks and benefits and how pet owners can evaluate them to decide which vaccines are appropriate to give their pets. This is a far more complicated subject than many opponents of vaccination claim. 

It is clear that vaccines, like any medical therapy, can cause harm. However, the evidence for specific types of harm is often poor, and the anxiety about vaccination is often based on fear, not real scientific evidence of real risks. Claims that vaccines cause autoimmune disease (12 or behavioral problems, anxieties about “toxins” such as mercury in vaccines, claims that lower “doses” of vaccines are safer than standard volumes (12), and the value of antibody titers as substitutes for vaccination are all subjects I’ve addressed here. There are few simple, absolute answers, but it is clear that the benefits of vaccination almost always outweigh the risks. However, the anti-vaccine movement is alive and well in veterinary medicine, and vaccine opponents have been all too effective at taking the reasonable concerns pet owners may have about vaccine safety and turning them into unreasonable fear.

In human medicine, we have seen the serious consequences of this fear. Vaccine-preventable diseases are making a comeback, and children are being harmed and killed by illnesses they should never have been allowed to contract. The World Health Organization has listed vaccine hesitancy as one of the top ten public health threats we face. One major element to the growing public health threat of vaccine refusal has been the use of exemptions from vaccine requirements for children attending public schools. While there are uncommon medical reasons to avoid vaccinating some children, exemptions based on the religious or personal belief of parents have reduced vaccine coverage and placed all children at greater risk, those who cannot or will not be vaccinated and even those who are, since vaccine protection is excellent but never perfect. 

In California, non-medical exemptions were prohibited by law in an effort to better protect public health. Unfortunately, anti-vaccine activists were able to undermine the law by seeking exemptions from deluded or unscrupulous physicianswilling to grant exemptions without legitimate medical and scientific foundations. This loophole had to be addressed in additional legislation giving the state health department authority to review medical exemptions when an excessive number of them are issued by an individual doctor or if a specific school has an excessively low vaccine compliance rate. This is an imperfect solution, but the original law has improved vaccination rates in the state, and it is likely the new measures will be somewhat helpful in reducing the risk posed by individual anti-vaccine activists.

In veterinary medicine, most vaccinations are not legally required for most pets. Vaccination rates are lower, and the occurrence of vaccine-preventable disease are consequently higher, than they should be, but the law considers pets to be property, so there is no real movement to require vaccination even if it is clearly in the best interests of the animals. The exception to this is immunization against rabies, which is often required at the state or local level in pets (almost always in dogs, and sometimes in cats and ferrets) because of the risk infected animals present to humans. 

Rabies is almost always fatal, and tens of thousands of people worldwide are killed by it every year. Most of these are exposed by domestic dogs. This is rare in the developed world because of long-standing and successful vaccination campaigns, so many people do not adequately appreciate the danger of reduced vaccine coverage. 

Medical exemptions to rabies vaccination are sometimes sought for pets with a history of adverse reactions to rabies vaccine, with conditions that might be exacerbated by vaccination such as autoimmune disease, and of course for many illegitimate reasons such as age or simply the owner’s perception that the vaccine is unsafe or not necessary. Local government often has discretion as to whether to grant such exemptions, and the process and criteria are variable and inconsistent. Anti-vaccine advocates have long wanted to reduce vaccination against rabies (and other diseases), and for the first time a state-level law has been passed which would facilitate this.

The state legislature in Delaware has passed a law allowing veterinarians to exempt individual dogs, cats, and ferrets from rabies vaccine requirements. This law is, unfortunately, a blank check to anti-vaccine vets that contains no protections against the kind of abuse and deception that has plagued efforts to improve compliance with vaccine mandates in humans. The law states:

Exemption from vaccination against rabies may be permitted if a licensed veterinarian has examined the animal and based on the veterinarian’s professional judgment, has certified in writing that at the time, vaccination would endanger the animal’s health because of its infirmity, disability, illness, or other medical considerations.

This allows complete personal discretion on the part of the veterinarian to determine whether or not a pet should be vaccinated without regard to any legitimate scientific standards. Plenty of alternative medicine vets have completely unscientific beliefs about the risks of vaccines, and these doctors will be able to exempt any pet from vaccination based solely on these beliefs. And if clients demand exemptions for reasons that are not scientifically valid, vets will undoubtedly feel pressured to grant them. There are no rules or constraints they can use as justification for denying illegitimate requests.

The law also makes reference to rabies titer testing. It has been argued that since a high rabies titer likely indicates protective immunity in most pets (some challenge testing has been done for this disease), titers could be used in lieu of vaccination in some cases. This is a reasonable argument, and if clear requirements for running and interpreting antibody titers were made, they might be an appropriate alternative to vaccination on a fixed schedule. However, this law does not address any of these issues and merely states that titers can be done, presumably however the individual veterinarian wants.

A titer test, in the case of these medical exemptions, may be administered to assist in determining the need for the vaccination.

This is entirely meaningless since it does not require a titer or define how titers should be measured or used to determine immune status. The complete lack of any input on this law by informed scientific experts in the subject is clear here. 

The law is titled “Maggie’s Pet Vaccine Protection Act.” The name refers to a pet whose owner believes her dog died from adverse effects of vaccination. This anecdote is tragic, but it does not demonstrate the owner’s belief to be true. The medical expertise behind the act comes from Dr. John Robb, an anti-vaccine zealot who has been at war against vaccination and much of the veterinary profession for years. Dr. Robb is an example of the kind of veterinarian who will use this new law to reduce the protection against rabies that vaccination provide both pets and humans based only on his own passionate but completely unscientific beliefs about vaccines. 

Reasonable changes to vaccination laws based on sound science are totally appropriate. It may be that titers are an effective substitute for vaccination in some cases. However, ill-considered and sloppy laws like this driven by passionate misconceptions about vaccines can only endanger pets and humans. This law is not in the best interests of companion animals or public health, and it is sad that the true danger of such antivaccine activism and laws such as this will only be clear once pets and people start dying of rabies in the U.S. as they do in places where vaccination is not available of common.

This entry was posted in Law, Regulation, and Politics, Vaccines. Bookmark the permalink.

27 Responses to New Delaware Rabies Law Undermines the Safety of Pets and the Public

  1. art malernee says:

    It may be that titers are an effective substitute for vaccination in some cases. >>>

    who says they are not that’s not selling or making pet rabies vaccine? Pet revaccination programs are economically not medically concieved is not new news. Pet vaccine makers and sellers should not be the people politicians use to write pet revaccnation laws.

  2. skeptvet says:

    Art, as usual you oversimplify and assume those who disagree with you have venal motives. Titers are only a useful substitute for vaccination if
    1. they reliable predict immunity
    2. we know how and when to do them so that we don’t have lapses in immunity
    3. pets are healthier in some meaningful way when vaccinated less often because of the use of titers.

    These may be true in some circumstances and not others. Titers for FHV-1 are useless because they don’t predict immunity. We don’t know what titer level, if any, predict immunity to canine influenza, so it cannot substitute for vaccination at this time. We don’t know how to predict when protective immunity will go away, so we can’t accurately decide how often we need to titer to avoid lapses in coverage. And no one has proven that pets vaccinated less frequently than current guidelines indicate are healthier, live longer, or have any other meaningful benefits if they don’t have know hypersensitivity or other documented adverse reactions to vaccination.

    You are right that vaccine makers should not write the vaccine laws. Neither should radical anti-vaccine activists like John Robb or politicians who don’t understand the science of vaccines and immunology. When laws are necessary regarding vaccination (and often they are not), they should defer to the consensus of scientific experts in relevant fields. This isn’t perfect, but it’s a damn sight better than how this law was written.

  3. art malernee says:

    I think the science for rabies revaccination In the usa ends once you have vaccinated dogs and cats once for rabies, then boostered this killed virus vaccine in a month and offered to run rabies titers if the owner or the government wants to know if they are still protected. If someone can show me a rabies law that is better at protecting pets than doing that that’s medically not economically concieved I would like to see it.

  4. L says:

    I worry about senior dogs and small breed dogs getting rabies vaccination after the age of ten.
    It took me nearly a decade to get a rabies vaccine waiver signed by a vet for my senior dog that is allergic to everything.
    I have the veterinary dermatologist bills to prove it. Treatment is lifelong and the flareups can be expensive.

  5. skeptvet says:

    I too would like to see evidence that there is a legal plan that protects pets and humans as effectively as the current approach and with fewer risks. No one has done that, and the fact that rabies transmission from dogs and cats to humans is almost nonexistent in the US and common in places where these species are not routinely vaccinated makes me reluctant to change the current practice without this real evidence, not just the belief that less vaccination is as effective and safer.

  6. skeptvet says:

    The problem is that there isn’t any evidence that rabies booster vaccines have anything to do with allergic dermatitis or that skipping vaccines will help.

  7. art malernee says:

    I too would like to see evidence that there is a legal plan that protects pets and humans as effectively as the current approach and with fewer risks. >>>>

    Laws that apply to veterinarians vaccinated for rabies are effective . Veterinarians lined up at avma conventions years ago to get rabies boosters even though the vaccine package insert put them in a category where once fully immunized nether titers or boosters were advised. So I agree if veterinarians are willing to risk Darwin awards getting themselves bolstered for rabes some veterinarians still believe pet booster revaccination programs are needed.

  8. Anna says:

    If you haven’t familiarized yourself with the work of Dr. Ron Schultz and Dr. Jean Dodds, you probably should. You want the science… here’s the science!

    https://www.rabieschallengefund.org/

  9. skeptvet says:

    False equivalence.
    1. Exposure risk is lower than dogs and cats (I don’t chase wildlife routinely).
    2. We don’t actually know how effective vaccination and titer testing is for humans because we can’t ethically do challenge studies. That is why, unlike dogs and cats, we all get post-exposure prophylaxis when exposed despite being vaccinated.
    3. “Darwin awards” implies there is significant and obvious harm from rabies boosters, and there is no evidence that’s true.

    You’re just repeating your beliefs here, not offering any evidence.

  10. skeptvet says:

    If you think I’m not familiar with the science, then you haven’t read any of the many, many articles on the subject I have written. I have no doubt you won’t since you already believe you know more than I do and aren’t really interested in the evidence for my claims, but here are some of the articles anyway. Oh, and Jean Dodds is a totally unreliable source on vaccination and most scientific issues. She has lots of long-held opinions, but no special expertise credentials in the field. I evaluate her claims, her book, and her general approach in several of the articles below.

    SkeptVet TV: Vaccine Risks- Real & Imaginary
    Vaccination for Cats
    Canine Vaccination: What, When, & Why?
    American Animal Hospital Association (AAHA) 2017 Canine Vaccination Guidelines
    Evidence Update: Vaccination and Autoimmune Disease
    Do Vaccines Cause Autism in Dogs?
    What’s the Right “Dose” of a Vaccine for Small-Breed Dogs?
    Evidence Update: Dodds Study on Vaccine Dose in Small Breed Dogs
    Canine Nutrigenomics by Dr. Jean Dodds: Science as Windowdressing

  11. greg says:

    “Veterinarians lined up at avma conventions years ago to get rabies boosters even though the vaccine package insert put them in a category where once fully immunized nether titers or boosters were advised”

    assuming you have been vaccinated, if you have potential exposure are you just hanging tight or are you getting a booster? I’ll take the booster, thank you very much.

  12. art malernee says:

    what is your definition of “potential exposure”?

  13. greg says:

    lets say that you are working on a pet with a 3 year lapse in rabies vaccine, normal exam stuff/checking mucous membranes…..then pet comes up neurologic.

    Are you hoping your immune system is solid or are you giving yourself the best chance at not dying?

  14. art malernee says:

    Best chance of not dying>>>>>
    You
    have moved the conversation to post exposure rabies vaccination which seems a little off topic from pre exposure rabies vaccination of dogs cats and humans. That’s OK but whats best for humans post or pre exposure rabies vaccination is often controversial. The vets at the avma convention were lined up for human pre exposure rabies booster shots. they had already been fully vaccinated just not that year. Need more history from you. Did the pet bite me? What kind of pet? Do not say pet Skunk because I will know you are playing with me.

  15. skeptvet says:

    Most pets are exposed by direct contact with whatever the vector animal in that area is. Bats most places, raccoons in the Eastern US, skunks in CA, coyotes some places, etc. Guidelines usually Humans are mostly exposed by bats, though some have gotten it from cats and dogs (e.g.). Many human cases identified as bat rabies variant happen without known bite or scratch, so standard recommendation is to treat as a potential exposure any contact at all with a bat (e.g.) Generally, criteria for exposure in humans are much stricter than those for dogs and cats (e.g.) because people are more concerned about humans.

  16. skeptvet says:

    I haven’t “moved the conversation,” I was just pointing out that humans are considered at risk for rabies when exposed even if they have been vaccinated and have protective titers because we don’t have challenge studies showing strong evidence of protection at specific titer levels. This means you can’t support the claim that it is ridiculous to consider revaccination in humans, as you seem to think.

  17. v.t. says:

    Art, I’ve had the series, one booster, and one titer.

    My clinic was also a licensed wildlife rehab, so we often had little critters we would nurse back to health and release when they were recovered. Myself and another tech were the only ones allowed to handle them (experience as well as reducing risk for a number of staff). My first exposure was with a young racoon who scratched my arm and policy dictated an emergency ER visit for the rabies series. It hurt like hell, it was expensive, it was a 28-day course, and many nights lying awake at night a bit scared out of my mind. (we monitored the racoon for 60 days or so, then released)

    The second incident was with a dog who chewed up my arm. The owner couldn’t produce proof of rabies vaccination (we knew the dog had never been vaccinated), so off to the ER I went (for a booster). It took over two months off work to heal and recover the use of my arm.

    The third incident involved a cat with unknown vaccination history. I’d already had the series and booster a few years before, so it was recommended to titer instead of a booster (the cat was quarantined and monitored for 45 days I think). It took over two weeks for the titer results, and I can tell you that was a harrowing two weeks with uncertainty. To be honest, I trusted more in the health of the cat than I did with the titer!

    I’ve witnessed young dogs and cats with rabies (thankfully, these were rare occasions). It’s the most heart-wrenching emotional experience I wouldn’t wish on anyone. Most cases weren’t because the owners were anti-vaccine, rather they were lazy and ‘ho-hum’ and obviously, never thought to vaccinate early, or at all.

    Our county is often under rabies quarantine (mainly due to skunks testing positive). This puts an incredible burden on our animal rescue organizations in neighboring counties who often work together to provide space and increased adoption rates.

    Only a few years ago, a dog in my neighborhood acquired rabies. The entire family and half the neighborhood kids had to be vaccinated. All of which could have been prevented by a single vaccine for the poor dog.

    Multiply these examples a thousand times in other areas of the country, add the anti-vaccine problem, and it becomes no different than the human vaccination problem.

    I too wish there was ample evidence and recommendations for duration and on the age of a pet in which to stop vaccinating. My pets are mostly seniors now, and no longer vaccinated for rabies, they are indoor-only and have zero exposure (save for the vet clinic for their veterinary care).

  18. Jill Missal says:

    This is insane! These people won’t stop until we have rabies, distemper, polio, measles, and god knows what else commonplace in the developed world again.

  19. art malernee says:

    I agree it is insane
    vaccination should not be based on how long it takes the earth to go around the sun. Its time we stop doing that in my opinion. It results in under and over vaccination. The FDA controls human vaccinations but not animal vaccines. The FDA requires
    that human revaccination programs follow conventional evidence based medicine
    by requiring evidence of benefit before allowing vaccine makers to label
    vaccines with revaccination intervals. Vet medicine does not follow
    conventional evidence based medicine when vaccinating. We historically follow
    traditional medical practices when vaccinating. Information available to the
    public about these traditional veterinary revaccination practices of adult
    dogs and cats show little evidence these practices were medically conceived
    and a lot of evidence they were economically conceived. Identical rabies
    vaccines for sale can have different revaccination schedules on the label . It is common knowledge that many dog and cat rabies vaccines labeled
    with one year revaccination intervals are just repackaged three year approved rabie vaccines with one year not three year labels. Same vaccine same bottle same label
    instructions except for different revaccination intervals. This fact was
    reported in a vaccine sarcoma (cancer related to vaccination) article in the America Veterinary Medical
    Association journal . Evidence of benefit can be shown for a second rabies booster vaccine since one vaccination does not always protect. Dogs and cats get rabies after having had only one rabies vaccine.One rabies vaccine only needs to protect 86.6% of the animals vaccinated to get government approval for sale in the USA. Rabies is a reportable disease in the USA and Canada which means if a dog or cat is found with rabies it must be reported to the government . The frequency of reported rabid dog and cat bites in our county is lower than the frequency of reported shark bites. The second rabies vaccination is not required by law in our county to be given for a full year after the first vaccine. Those clients whose animals run free in the everglades may wish to given the second rabies vaccine sooner the a year. This is to allow the amnestic response from the second vaccination to increase efficacy of the vaccine. I can provide no evidence of medical benefit for additional series of rabies vaccines beyond the second rabies vaccination to justify the risk and cost of vaccination. Historic evidence exist that rabies revaccination programs are economically conceived by vaccine manufactures that want to sell vaccines, veterinarians that want to use annual rabies vaccinations as a carrot or stick to get patients in for wellness care and local governments that want veterinarians to collect annual rabies licence fees when they vaccinate for rabies.

    Current Trends Compendium of Animal Rabies Control, 1987 Prepared by: The National Association of State Public Health Veterinarians, Inc. *
    Part I: Recommendations for Immunization Procedures

    The purpose of these recommendations is to provide information on rabies vaccines to practicing veterinarians, public health officials, and others concerned with rabies control. This document will serve as the basis for animal rabies vaccination programs throughout the United States. Its adoption will result in standardization of procedures among jurisdictions which is necessary for an effective national rabies control program. These recommendations are reviewed and revised as necessary prior to the beginning of each calendar year. All animal rabies vaccines licensed by the U.S. Department of Agriculture and marketed in the United States are listed in Part II of the Compendium, and Part III describes the principles of rabies control.

    VACCINE ADMINISTRATION It is recommended that all animal rabies vaccines be restricted to use by or under the supervision of a veterinarian.

    VACCINE SELECTION In comprehensive rabies control programs, it is recommended that only vaccines with 3-year duration of immunity be used. This eliminates the need for annual vaccination and constitutes the most effective method of increasing the proportion of immunized dogs and cats.

  20. skeptvet says:

    Annual revaccination after the 2nd dose isn’t recommended by any of the current guidelines (e.g. AAHA, WSAVA), so while we agree it is necessary, it also isn’t the standard of care or what I’m talking about, and none of the practices in my area do this. I don’t know what you are trying to demonstrate by citing the 1987 compendium, but here’s what the most recent version (2016) says-

    “Local governments should initiate and maintain effective programs to ensure vaccination of all dogs, cats, and ferrets and to remove stray and unwanted animals. Such procedures have reduced lab- oratory-confirmed cases of rabies among dogs in the United States from 6,949 cases in 1947 to 89 cases in 2013. Because more rabies cases are reported annually involving cats (247 in 2013) than dogs, vaccination of cats should be required.”

    “Rabies virus antibody titers are indicative of a response to vac- cine or infection.Titers do not directly correlate with protection because other immunologic fac- tors also play a role in preventing rabies and our abilities to measure and interpret those other fac- tors are not well-developed. Therefore, evidence of circulating rabies virus antibodies in animals should not be used as a substitute for current vaccination in managing rabies exposures or determining the need for booster vaccination.”

    “Adherence to a regular rabies vaccination schedule is critical to protect animals against recognized and unrecognized rabies exposures…Regardless of the age of the animal at initial vaccination, a booster vaccination should be administered 1 year later….Following the initial vaccination, booster vaccinations should be given in a manner consistent with the manufacturer’s label…There are no laboratory or epidemiological data to sup- port the annual or biennial administration of 3-year vaccines after completion of the initial vaccine series (ie, the initial vaccination and 1-year booster vaccination).”

    Whether or not vaccination beyond the second dose is necessary is something that has to be established by evidence, ideally challenge studies or epidemiological data showing outcomes of exposed animals with different vaccination histories, and that data is not available. However, the practice of giving additional boosters every 3 years is not driven by veterinarians–it is the law in most states and is driven by regulators concerned about human health risks. If we can generate evidence that shows no further vaccination is necessary after the 1-year booster, then we can get that law changed. I haven’t yet seen any such evidence, though, and the risks of leaving animals and people vulnerable to rabies is great enough that we should have it before we decide boosters aren’t needed.

  21. art malernee says:

    does anyone know what happened to the data collected by the rabies challenge fund? They have supposedly collected over 400 thousand dollars in donations. Its been a long time since they say the study ended. I hope it’s published open source not behind a paywall.

  22. L says:

    My dog is due for his 3 year rabies shot, I have every intention with complying with the law.
    My question is, my dog has always gotten the Zoetis, Defensor brand, I was thinking of going to Petco Vaccination Clinic to save a few bucks (things are tight), however I called them and they use a different brand of rabies vaccine. Should I be concerned? It appears to be the same thing.
    Is there a preferred brand among vets?
    Forgive me for being picky, but I don’t want to risk a reaction/adverse effects.
    Thanks in advance

  23. skeptvet says:

    There is no evidence of any meaningful difference between brands.

  24. Cloudskimmer says:

    I was disappointed that the vote in the Delaware legislature was unanimous in favor of this bill. Did no one point out that this was a bad idea? Did none of the legislators realize that this would increase the risk of people contracting rabies? Hopefully when the first rabies case occurs in the state, they will realize their mistake and rescind the bill. Is there any part of the bill that requires reporting by vets who exempt their patients from vaccination, and tracking by the health department?

  25. art malernee says:

    . Is there any part of the bill that requires reporting by vets who exempt their patients from vaccination, and tracking by the health department?>>>>

    some places like my county stop selling rabies tags if they get a letter. Its like your accountant can send a exemption letter to the irs to get you out of paying taxes every year. Sunshine laws are waived so press cannot show the public. Love to know how many waivers are written and how long they last. Need sunshine laws to find out what the politicians are doing behind closed doors.

  26. Brenda Zeller says:

    I’m curious about the prevalence of FISS – Feline Injection Site Sarcoma. I lost my indoor cat to that several years ago. A cancerous cyst formed beneath the site of her rabies vaccination and eventually ate through her spine. We had no idea it was there. My vets over the years exempted my indoor kitties from the shot because of that. Now, my vet insists on it saying it’s better now because they give the injection in the leg and if FISS occurs, they just cut off their leg. Somehow I am not comforted by that. Your thoughts please.

  27. skeptvet says:

    The incidence of injection-site sarcomas has been reported in a number of studies, and it varies widely from 1 in 1,000 cats to 0.6 in 10,000 cats or even less (1, 2, 3). Incidence varies geographically, suggesting that genetics or other environmental risk factors are part of the picture. This risk is low, but of course it is difficult to treat, so a number of steps have been taken to try and reduce the risk further, including a switch to non-adjuvented vaccines, reduction in the frequency of vaccination, and as you know giving vaccines in locations where a curative surgery can be done if a FISS develops. It is unclear if these measures have reduced the incidence because the tumors are rare and have multiple causes/risk factors, so tens of thousands of cats have to be studied for over a decade to make strong statements about changes in occurrence.

    Here is the latest recommendation from the feline specialist community.

    What we have to remember is that this risk needs to be weighed against the benefits of vaccination. For an outdoor, free-roaming cat, there is no question that the risk of harm from infectious diseases is MUCH greater than FISS risk. For an indoor only cat, the balance is closer, and so long as escapes are effectively prevented, reducing vaccination after the initial series and 1-year boosters is reasonable.

Leave a Reply

Your email address will not be published. Required fields are marked *