Re-Vaccination:
Vaccination for Previously Vaccinated Dogs and Older Puppies
By Christie Keith
This
article is meant to inform you of research, opinions, and personal
reflections that might be useful to you in determining a disease
prevention program for your pet. It is educational in nature, and is not
intended as veterinary advice. The author cannot be held responsible for
any unfavorable results from the use of this information. Readers should
seek professional veterinary advice for any health decisions involving
their pets.
Annual shots: Many veterinarians insist on them, boarding kennels and
groomers require them, and keeping "current" on vaccinations has become
one of the hallmarks of responsible pet ownership. But are they really
necessary? And are they safe?
I wish I could tell you that your veterinarian will be able to answer
these questions for you. At this time, however, unless a veterinarian
has a special interest in immunology, he or she probably will not have
all the information needed to give you an informed response. I also wish
I could tell you that there is a definite answer to these questions,
based on science and research; there isn't. And ultimately, no matter
what your veterinarian suggests, or what I believe, or what you read as
you research this issue, this is your decision to make.
Are Vaccines Really Harmful?
Some have attributed every ill of the canine and feline pet populations,
from allergies to arthritis to severe immune system breakdowns, to
excessive use of vaccines. Others, most notably vaccine manufacturers,
insist the vaccines are harmless and that the benefits outweigh the
risks. Where does the truth lie?
A few years ago, the Colorado State University School of Veterinary
Medicine became the first veterinary college to issue a vaccination
schedule that recommended against annual vaccinations. In their new
protocol they wrote, "We are making this change after years of concern
about the lack of scientific evidence to support the current practice of
annual vaccination and the increasing documentation that over
vaccinating has been associated with harmful side effects. Of particular
note in this regard has been the association of autoimmune hemolytic
anemia with vaccination in dogs and vaccine-associated sarcomas in
cats...both of which are often fatal."
There is some evidence to suggest to even the most ardent vaccine
supporter that there are risks to vaccination. In cats, there is an
alarming incidence of injection site sarcomas, an aggressive and often
fatal cancer. In dogs, there is a correlation between autoimmune
hemolytic anemia and vaccination (Dodds, 1985; Duval and Giger, 1996),
and an ongoing study at Purdue University has found that vaccinated
dogs, but not unvaccinated controls, have formed antibodies to their own
cells (Larry T. Glickman, DVM, "Weighing the Risks and Benefits of
Vaccination," Advances in Veterinary Medicine, Vol. 41, 2001).
Immunocompromised dogs vaccinated for canine distemper have been
reported to develop post-vaccinal encephalitis (Meyer, "Vaccine
Associated Adverse Events," Veterinary Clinics of North America, May
2001). Dogs with inhalant allergies are known to worsen after
vaccination (Frick and Brooks, 1983).
According to leading canine vaccine researcher Dr. Ronald Schultz,
Chair of the Department of Pathobiology at the University of
Wisconsin-Madison School of Veterinary Medicine, and editor of the
textbook
Veterinary Vaccines and Diagnostics, "It is becoming increasingly
more evident that it is no longer true to say, 'Well, even if the
vaccine doesn't help, it won't hurt.' There are some canine vaccination
programs that have no scientific justification that may have the
potential of causing harm."
So
What Do You Do?
I know we'd all like to think we can put a magic barrier around our
animals that will protect them from all disease and have 100 percent
effectiveness and no risk. The closest you'll ever get to that is to
build a barrier of radiant good health, which comes from excellent
breeding practices, never suppressing disease symptoms, and excellent
holistic husbandry including diet, environment, exercise, and TLC.
In the real world, such a barrier will never be perfect. We have to
accept some risk in one direction or another.
Those who don't vaccinate at all must accept the risk that the
animals in our care might get sick from an infectious disease; with
puppies, the risk is great that they will die, and even if they live,
they might have lingering effects from the disease, and the vet bills
(and feelings of guilt) might be considerable. Those who do vaccinate
must accept the risks of side effects, allergic reactions, vaccine
failures, cancer, and autoimmune disease. Those who believe in
homeopathic theory will have to accept the risk that they will be
trading acute illness for chronic disease and vaccinosis.
Everyone has to educate themselves the best they can, weigh the risks
vs. benefits, and come to their own decision. If what you want is zero
risk and all benefit, it doesn't exist and you will never find it.
Am I saying vaccines are harmless? No. I think they do a lot of harm.
I manage to believe that while still knowing and acknowledging that they
are also effective in protecting against certain acute diseases. They
are in fact so effective that most people reading this, whose dogs have
already been immunized against parvo and distemper, really are on very
solid ground when they stop vaccinating, because their dogs are already
immune.
For those people, the decision
not to vaccinate at all
is not on the table. The animals have already been vaccinated. The only
question is, do you need, or want, to give them "booster" shots? If not,
how can you be sure your animal is fully protected against disease? If
yes, what boosters should be given, and how often?
There are some general guidelines and immunology studies that might
be useful to you in researching whether or how to give booster shots to
your dogs. First, I want to stress that all of this information is based
on an assumption that your dog was successfully vaccinated in the past.
That is a big assumption to make, and before making it, please be sure
you have read my section on
puppy vaccination.
Just because your dog had vaccines given in the past does not guarantee
that those vaccinations were successful and that your dog is in fact
immune to those diseases.
What
Vaccines are We Talking About?
Let's look at the commonly used canine vaccines.
Other than rabies, the two most serious canine viral diseases are
canine parvovirus and canine distemper. (Since rabies vaccination is a
matter of law, rather than science, I'm not going to discuss it here.)
According to Dr. Schultz, protection against canine parvovirus and
canine distemper from successful vaccination is long term, probably
lifelong. (Kirk's
Current Veterinary Therapy XIII; 2000; "Vaccines and Vaccinations:
Issue for the 21st Century", Richard B. Ford and Ronald D. Schultz; (Kirk's
Current Veterinary Therapy XI, "Canine and Feline Vaccines," Phipps,
Schultz; R.D. Schultz, "Considerations in Designing Effective and Safe
Vaccination Programs for Dogs," May 2000; (Schultz, "Duration of
Immunity to Canine Vaccines: What We Know and Don't Know.")
For more information on duration of immunity to vaccination to canine
distemper and canine parvovirus, you can read some of Dr. Schultz's
research in his article
"Considerations in Designing Effective and Safe Vaccination Programs for
Dogs."
What About the Other Vaccines?
The other common canine vaccines are Canine Adenovirus-2 (CAV-2), also
known as Canine Infectious Hepatitis; Canine Bordatella (a bacteria that
is part of the kennel cough complex); Canine Parainfluenza (a virus that
is part of the kennel cough complex), Leptospirosis (a bacteria that
causes kidney disease), and Canine Coronavirus, an intestinal virus.
Other canine vaccines that are sometimes given are for Lyme disease and
Giardia.
Canine Infectious Hepatitis (CAV-2)
There has been no case of infectious hepatitis in the US in 20 years,
according to Dr. Schultz. This vaccine does cross-protect against CAV-1,
part of the kennel cough complex (see below).
Kennel Cough
The kennel cough complex (bordatella, parainfluenza, CAV-1) is a set of
treatable diseases similar to a cold. A normal, healthy animal shouldn't
become seriously ill with any of them. Immunity to CAV-2 (infectious
hepatitis) gives cross protection to CAV-1, and the CAV-2 vaccine
provides similar immunity to parvo and distemper (many years, probably
lifelong). The bordatella vaccine is extremely ineffective (as many
bacterial vaccines are) and I believe, considering how often you have to
repeat it, the risk mounts up until it outweighs the benefit.
Parainfluenza vaccine is also not all that effective, however, again, I
consider the risk to outweigh the benefit for the whole kennel cough
complex. I have never given any of these vaccines in the period since
November 1985 and have never had a dog get any of them, despite being at
shows, classes, dog parks, and living with someone who worked in
shelters and had foster dogs at our house who had active kennel cough.
Some dogs do develop pneumonia or other complications from kennel
cough. I consider this to be rare, and also a sign that the dog had a
pre-existing susceptibility to respiratory problems. However, it's
important to realize that the risk, even if rare, does exist, when
deciding on a course to follow as regards kennel cough vaccination.
Leptospirosis
This vaccine has more adverse effects reported than all other canine
vaccines combined. It's not very effective and even when it does give
protection, it doesn't last very long. Most dangerously, while it
prevents expression of disease in dogs, it does not prevent them from
shedding the bacteria. This carrier state makes them a risk to other
animals and people, because they can "have" lepto and you don't know it.
(Lepto is transmissible to humans.) Again, to me, the risk outweighs the
benefit.
Lepto is treatable if caught early. In most cases, the reason lepto
is so dangerous is that owners and veterinarians don't think of it fast
enough. Learn the symptoms of leptospirosis and if your dog shows any of
them, don't delay; have him or her tested and treated for lepto
immediately. As with kennel cough, a few dogs do become very ill, or
even die, from leptospirosis, despite treatment.
Giardia
Giardia is an opportunistic pathogen. If a dog is healthy, giardia will
naturally be kept in check by beneficial microbes and the dog's immune
system. Very large numbers of dogs in California who are totally
asymptomatic can have giardia cultured from their stool. I am not aware
of any veterinary schools, or immunology or vaccine researchers, who
recommend the routine use of this vaccine.
Coronavirus
This is the classic "vaccine in search of a disease." Except in very
young puppies, coronavirus does not seem to cause clinical disease in
dogs. They cannot induce disease with it in the laboratory. Many,
perhaps most, dogs have coronavirus in their intestine all their lives.
(Schultz, "Emerging Issues: Vaccination Strategies for Canine Viral
Enteritis," 1995.) According to Texas A&M University's "Vaccine
Protocols and Schedule," "(T)here are no studies that show that use of
the vaccine reduces morbidity or mortality. (Mansfield 1996.) "The risk
has to be said to outweigh the benefit on this one, as there doesn't
appear to be any benefit.
Lyme Disease
Lyme Disease is caused by an organism called Borrelia burgdorfieri,
which is transmitted by a tick. Borrelia is a spirochete, a highly
coiled bacterium.
Lyme Disease is very serious in humans, although scientific opinion
generally holds that it is rarely serious in dogs. Most experts contend
that it causes only brief acute illness in dogs, or no symptoms at all.
Dogs in endemic areas will often test positive for Lyme and have no
symptoms, or at least, no observable symptoms.
Many dog owners, and some veterinarians, don't agree with this view,
and claim to have observed serious debilitating disease in their dogs as
a result of infection with Borrelia.
There is also debate over how widespread Lyme disease really is. Some
argue that since 90 percent of human Lyme cases occur in 100 counties in
eight states, it's not widespread at all. Others point out that Lyme is
grossly underreported and underdiagnosed, and epidemiology information
on this disease is probably a few years behind, as well.
I don't know the truth of the situation. There are many tick borne
diseases that we know, but more that we don't. Most ticks do have more
than one of these, and if a dog has contracted Lyme, they probably also
contracted one of the others. Perhaps both groups are correct, and one
of the other tick diseases is actually responsible for the sick dogs'
symptoms. Or perhaps current conventional thought is wrong, and Lyme
really is serious and common in dogs.
Despite these controversies and despite the potential seriousness of
the disease, the following points convince me that this vaccine is not a
good one, even in endemic areas:
One, only 19 of 27 veterinary colleges in North America give Lyme
vaccination, and the other 8 only give it if the owner requests it.
Two, it can often cause inflammatory arthritis in dogs who get it,
just like Borrelia itself can.
Three, the human version of this vaccine was recently removed from
the market.
Four, like all bacterial vaccines, immunity doesn't last long and
thus the vaccine needs frequent repetition to be effective, which means
you are exposing your dog to the risk again and again, unlike viral
vaccines which provide years, probably a lifetime, of immunity.
Five, I question how useful this vaccine is:
"One study in an endemic region demonstrated that 89.6 percent of
healthy dogs had positive Lyme titers. There is no apparent correlation
between positive Lyme titers and the occurrence of clinical signs. Only
4.8 percent of naturally exposed seropositive dogs demonstrated a limb
or joint disorder with lethargy, fever, or inappetence; however, 4.6
percent of seronegative dogs also demonstrated such disorders. Most dogs
that are seropositive for Lyme disease have not exhibited clinical signs
of the disease." (Meryl P. Littman, VMD, ACVIM; Department of Clinical
Studies School of Veterinary Medicine, University of Pennsylvania;
Compendium on Continuing Education for the Practicing Veterinarian,
November 1997.)
How
Long Does Vaccine Immunity Last?
The only correct answer to this is that no one really knows. Duration of
immunity tests are done by vaccine companies, but usually run only for
one year. It's not that the vaccination "wears off" after a year, but
that the test ended at one year, usually for financial reasons. A
long-term vaccination duration of immunity study would cost a fortune to
conduct, and by the time it was ended, the product being tested would
most likely be outdated. In addition, such a test would require dogs to
be confined in a special pathogen-free environment for their whole
lives, and be inhumane as well as expensive.
Since epidemiology tells us that canine parvovirus and canine
distemper are almost unheard of in vaccinated adults, we can conclude
that in most cases, the immunity to those vaccines lasts many years,
probably a lifetime. What about the others?
Vaccines for bacterial disease do not usually provide long-term
immunity. This is true of natural infection, also. It's why you never
get chicken pox (a virus) again after you've had it once, but you could
have strep throat (a bacteria) many times during your life. Bacterial
vaccines for dogs are bordetella, leptospirosis, and Lyme disease. If
you have decided to use these vaccines, you need to be aware that the
immunity they provide will not last, and you will need to repeat the
vaccinations at certain intervals. What those intervals are will depend
on your own unique circumstances. Obviously, this need to give the
vaccine repeatedly increases the risk of the vaccination.
Specific duration of immunity information for these and other canine
vaccines is available in Dr. Schultz's article
"Considerations in Designing Effective and Safe Vaccination Programs for
Dogs."
No "Booster" Effect
Since no one can be absolutely sure that an animal is immune to
something unless they actually encounter it, some people feel that it's
best to give "booster shots" to increase immunity. Some breeders like to
give "booster shots" to their bitches before breeding them, so they'll
have plenty of immunity to pass on to their puppies. Other owners just
feel safer giving "booster shots," and of course, most veterinarians
truly believe that they should be given "just in case," on a schedule
that will commonly range from every year to every three years.
The only flaw in this reasoning is that it doesn't appear that giving
shots to already-immune animals "boosts" much of anything. You cannot
make an immune animal "more immune." Re-vaccinating an already-immune
animal has little or no benefit; the previous immunity will act like
maternal antibody and inactivate the vaccine, and immunity is not
"boosted" at all. So you have all the risks of the vaccination, and no
benefit. (Schultz, R.D., "Current and Future Canine and Feline
Vaccination Programs." Vet Med 3: No. 3, 233-254, 1998.)
What Can I Give My Dog to Minimize the Negative Effects of
Vaccines?
The same thing that protects your dog from disease is what will protect
them from the ill effects of vaccination: Radiant good health. There are
no shortcuts to good health. It involves breeding and feeding for
health, as well as giving clean air, clean water, plenty of appropriate
companionship, mental stimulation, and exercise. Most of us have dogs
whose genetics are not in our control, and in many cases, neither were
their early lives. Those animals are probably not healthy enough to
resist disease on their own, but sadly, they are the very dogs who are
most likely to be negatively affected by vaccination.
Many people routinely use and recommend the homeopathic remedy thuja
to counteract vaccine effects. Thuja will not protect your dog from
harmful effects of a vaccine unless thuja, out of the over 2000 remedies
in the homeopathic materia medica, happens to match your dog's exact
symptoms.
Thuja's reputation for helping with vaccine reactions arose during
the days when the only vaccine that existed was the smallpox (cowpox)
vaccine. The blanket use of thuja to protect after a vaccination is not
based on homeopathic principles, and using thuja in this way is at best
pointless (unless it happens to be the right remedy to match your dog's
unique symptoms). What you need to do, if you decide to vaccinate, is
observe the dog for his or her own unique reaction and symptom picture,
and pick the single most similar remedy. In other words, the remedy
which, when given to healthy people, produces the same symptom picture
which your ill dog has. This is not something a pet owner should do on
their own, but only with the advice of a
skilled homeopathic
veterinarian.
Make sure that your animal is extremely healthy when they are given
vaccines. Not only are vaccines licensed for use in healthy, clinically
normal animals only, an animal who is sick will probably not be able to
form good immunity to the vaccination. They will suffer increased risk
and reduced benefit.
Many people like to give herbal supplements before and after
vaccination. Gentle herbs such as Echinacea, Oregon grape, and others
might well have some benefit to your dog. For more information on using
herbs or supplements to combat the negative effects of vaccination,
consult a holistic veterinarian or the book
Herbs for Pets by herbalists Mary Wulff-Tilford and Greg Tilford.
References
1. "The incidence of canine distemper, canine parvovirus, canine
adenovirus, and feline panleukopenia among vaccinated adults (>1 year of
age) is virtually zero. The correlation among vaccination, the
development of a "positive" antibody response, and protection from
exposure to virulent virus is excellent. Furthermore, protection from
exposure derived from immunization is sustained for periods as long as 5
or 6 years or more." (Kirk's
Current Veterinary Therapy XIII; 2000; "Vaccines and Vaccinations:
Issue for the 21st Century", Richard B. Ford and Ronald D. Schultz.)
2. "A practice that was started many years ago and that lacks
scientific validity or verification is annual revaccinations. Almost
without exception there is no immunologic requirement for annual
revaccination. Immunity to viruses persists for years or for the life of
the animal." (Kirk's Current Veterinary Therapy XI, "Canine and
Feline Vaccines," Phipps, Schultz.)
3. "In our studies, puppies vaccinated annually with modified
live CPV-2, CDV and CAV vaccines received no added benefit from annual
revaccination throughout a period of 7 years when compared to dogs that
were vaccinated as puppies then challenged with virulent virus at 7
years of age. Both groups of dogs were protected from challenge
infection with CPV-2, CDV and/or CAV." (R.D. Schultz, "Considerations in
Designing Effective and Safe Vaccination Programs for Dogs," May 2000.)
"(W)e have found that annual revaccination, with the vaccines that
provide long term immunity, provides no demonstrable benefit and may
increase the risk for adverse reactions." (Schultz, "Duration of
Immunity to Canine Vaccines: What We Know and Don't Know.")
4. "Companion animal vaccination guidelines are currently
undergoing critical scrutiny by representatives from private practice,
industry, and academia. Despite widespread recommendations for annual
revaccination, information available today suggests that current
vaccination practices in North America do not necessarily correspond
with the body of knowledge pertaining to duration of immunity from
licensed vaccines. As a direct result, companion animal practitioners
should expect significant changes in the current standard of practice
pertaining to the administration of vaccines to dogs and cats.
"Among the most significant changes anticipated in the future will be
the recommendation to discontinue routine administration of annual
booster vaccinations to adult dogs (distemper virus and parvovirus) and
cats (panleukopenia, feline herpesvirus 1, and feline calicivirus). The
incidence of canine distemper, canine parvovirus, canine adenovirus, and
feline panleukopenia among vaccinated adults (>1 year of age) is
virtually zero. The correlation among vaccination, the development of a
"positive" antibody response, and protection from exposure to virulent
virus is excellent. Furthermore, protection from exposure derived from
immunization is sustained for periods as long as 5 or 6 years or more. (Kirk's
Current Veterinary Therapy XIII, published in 2000:"Vaccines and
Vaccinations: Issue for the 21st Century", Richard B. Ford and Ronald D.
Schultz.)
5. These notes were taken by Betty Lewis, AHT, from a seminar
she attended given by Dr. Schultz in August 2001, and are used with
permission:
Core Vaccines are distemper, adenovirus, parvo and rabies. He says
all dogs must have these.
His protocol is to give a single vaccine (he recommends the 5-way
with the lepto left out) at 12-14 weeks of age. Wait two weeks and run
parvo and distemper titers. If the dog has an adequate titer measure at
Cornell as 1:100 or higher, there is no need to repeat either the
vaccination or the titer for the life of the dog. Rabies is given
separately and has to be re-vaccinated by state law.
**Giving multiple vaccinations does not boost immunity, and, in some
cases may erode it.
Even though he recommends that the titer level be 1:100, he does not
recommend re-vaccination unless there's a really low titer. He says it
probably won't improve immunity, though it may make you feel better.
Principles of basic vaccine protocol include having breeders give
vaccinations at home so puppies don't go to the vet's office (sources of
infection).
The rabies vaccine is the most reacto-genic, he said, so best to give
it separately. Benadryl can be given prior to a rabies vaccine. It will
"dampen" the reactive effect of the adjuvants, but won't interfere with
the immune response.
Giardia vaccine is not recommended and a side effect is granulomas at
the site.
Immunologic imprinting
This refers to the fact that the immune system should be vaccinated only
when it is ready and at its optimum. If you vaccinate an immature immune
system or one not capable of responding fully for any reason, and you
get only a partial response, re-vaccinating will never give a better
response.
There has not been a recorded case of canine infectious hepatitis in
the US in the last 20 years. (CAV-2)
"Of course vaccines can trigger neurological and endocrine diseases;
didn't I say that there is an intimate relationship between the immune,
neurological and endocrine systems?"
By law the vaccine companies have to put 2-3 times the required dose
into the vial.
If a breeding dog can't develop a titer, it's not a good breeding
prospect b/c it will pass on the poor immune system.
The three species with the most tendency to auto-immunity are humans,
dogs and inbred mice.
He said that boosting a mother's vaccine prior to pregnancy will not
increase the level of maternal immunity in the puppies. It is safer for
the bitch to wait until after weaning to vaccinate.
6. "In the past, it was believed that annual vaccination would
not hurt and would probably help most animals. However concerns about
side effects have begun to change this attitude. One disadvantage to
over-vaccinating is cost. The client is paying for something with no
effect or with the potential for an adverse reaction. I believe that
adverse effects are increasing because we are putting more and more
components into these animals ...There is a real concern that vaccines
may predispose certain genetically susceptible individuals to
immune-mediated disease. The more antigens we administer, the higher the
potential for hypersensitivity. Type 1 is IgE mediated; type 2 cytotoxic
antibody mediated; type 3 immune-mediated, type 4 cellular mediated. All
of these hypersensitivies are natural parts of the immune response, but
they cause a certain amount of tissue damage. In many cases it is
impossible to show a direct connection between damage and a vaccine,
since it is the accumulation of many antigens over many years that
results in clinically evident disease." (From The Journal of the
American Veterinary Medical Association, vol. 207 Aug 15, 1995.)
7. "A practice that was started many years ago and that lacks
scientific validity or verification is annual revaccinations. Almost
without exception there is no immunologic requirement for annual
revaccination. Immunity to viruses persists for years or for the life of
the animal." (Kirk's Current Veterinary Therapy XI, "Canine and
Feline Vaccines," Phipps, Schultz.)
8."(W)e have found that annual revaccination, with the
vaccines that provide long term immunity, provides no demonstrable
benefit and may increase the risk for adverse reactions." (Ronald D.
Schultz, Professor and Chair, Department of Pathobiological Sciences,
School of Veterinary Medicine, University of Wisconsin-Madison;
"Duration of Immunity to Canine Vaccines: What We Know and Don't Know.")
9. "Dogs' & cats' immune systems mature fully at 6 months. If
a modified live virus (MLV) vaccine is given after 6 months of age, it
produces an immunity which is good for the life of the pet (i.e. canine
distemper, parvo, feline distemper). If another MLV vaccine is given a
year later, the antibodies from the first vaccine neutralize the
antigens of second vaccine, and there is little or no effect. The titer
(level of immunity) is not 'boosted' nor are more memory cells induced.
-Schultz, R.D. - Current & Future Canine & Feline Vaccination Programs.
Vet Med 3: No. 3, 233-254, 1998." (Summary from http://www.critterfixer.com/new_principles_of_immunology.htm)
10. "Since the mid 1970's we have done a variety of studies
with various canine vaccines to demonstrate their duration of immunity.
From our studies it is apparent, at least to me, that the duration of
immunity for the four most important canine vaccines (core vaccines) is
considerably longer than one year. Furthermore, we have found that
annual revaccination, with the vaccines that provide long term immunity,
provides no demonstrable benefit and may increase the risk for adverse
reactions." (Ronald D. Schultz, Professor and Chair, Department of
Pathobiological Sciences, School of Veterinary Medicine, University of
Wisconsin-Madison, "Duration of Immunity to Canine Vaccines: What We
Know and Don't Know.")
11. "In the past, it was believed that annual vaccination
would not hurt and would probably help most animals. However concerns
about side effects have begun to change this attitude. One disadvantage
to over-vaccinating is cost. The client is paying for something with no
effect or with the potential for an adverse reaction. I believe that
adverse effects are increasing because we are putting more and more
components into these animals ...There is a real concern that vaccines
may predispose certain genetically susceptible individuals to
immune-mediated disease. (Journal of the American Veterinary Medical
Association, vol. 207 Aug 15, 1995.)
Web Resources
Considerations in Designing Effective and Safe Vaccination Programs for
Dogs
Duration of Immunity
New Vaccination Protocols
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