5 March 2017 Update: Separate Leptospirosis Vaccine is now available at some vet clinics! Find out more here!

 

Original article written June 7

Preface Vaccination is a confusing subject. We read on US websites like this that we should not vaccinate annually. Yet our local neighbourhood vet sends us yearly reminders to schedule Donna for her annual vaccination. And I actually didn’t even know diseases Donna was being vaccinated for until I started researching for this article.

I finally got around to speaking with three different vet clinics to get a clearer picture of vaccination that I feel more comfortable and confident to write about and share with you here. This article has also been read by Dr Joanna Paul from Creature Clinic just to make sure that I have been accurate and you can trust this article.

This article was written just weeks before a suspected lepto outbreak occurred at a local doggy swimming pool. Thereafter, news articles carried vet advice to keep pets vaccinated. Vaccination is an important topic that we should know more about, and I hope you will find this post, written from the perspective of living in Singapore useful for you.

This is a long post, but I have provided a quick summary for those of you who prefer that at the end of the post. So scroll all the way down if you prefer to just read the summary. ;)

Our dogs can and should receive Core Vaccinations every 3 years or longer

Did you know that the Global Veterinary Community (WSAVA) Owner/Breeder guidelines says, ‘for the core vaccines, the Vaccination Guidelines Group recommends re-vaccination at either 6 months or 1 year of age, then not more often than every 3 years’?

This is because “dogs that have responded to vaccination with …core vaccines maintain a solid immunity … for many years in the absence of any repeat vaccination (Bohm et al. 2004, Mouzin et al. 2004, Schultz 2006, Mitchell et al. 2012)”. Since they can maintain immunity for 3 years or longer, our dogs don’t actually need annual vaccinations!

Titer tests are helpful for checking if your dog still has antibodies from her last vaccination booster shot to continue to give her immune protection against parvovirus, adenovirus and distemper. If your dog continues to have these antibodies, she doesn’t need another vaccination at the point of test.

To learn more about titer test cost and where to get it done in Singapore, click here.

So why do we still have the practice of annual vaccinations predominant locally in Singapore?

Well first, let’s take a look at what annual vaccinations our dogs are taking. For this, I’m referencing what Donna’s regular neighbourhood vet has administered to her for her annual vaccinations in both 2013 and 2014.

• Fort Dodge Duramune^® Max 5/4L – more about
  • Duramune^® Max 5 protects against diseases caused by Canine Distemper, Adenovirus Type 1 (Hepatitis), Adenovirus Type 2 (respiratory disease), Parainfluenza, and Parvovirus. All viruses in this vaccine are modified live versions of the virus.
  • The shot also included 4 strains of Lepto bacteria
    • LCAN – Leptospira canicola
    • LGRIP – Leptospira grippotyphosa
    • LICT  – Leptospira icterohaemorrhagiae
    • LPOM – Leptospira pomona

According to Donna’s health booklet from the vet, the core vaccines that are necessary to administer include: – Parvovirus, Distemper and Adenovirus. These are also the vaccines that are necessary but do not need to be administered more often than every 3 years.

 

Some Optional Vaccines (e.g. for Kennel Cough and Leptospirosis) require yearly booster shots

It is the optional vaccines – the 4 strains of lepto bacteria – in Donna’s re-vaccinations that is keeping us returning year after year for annual vaccinations. Unlike the core vaccines, our dogs don’t stay immune with these optional vaccines for as long a time.

Optional vaccines for Leptospira, Bordetella and Borrelia (Lyme disease) … also parainfluenza virus components, require more frequent boosters for reliable protection (Ellis & Krakowka 2012, Klaasen et al. 2014, Ellis 2015, Schuller et al. 2015)
– WSAVA Vaccination Guidelines, pg 8/45 Revaccination of Adult Dogs

Core Vaccinations can be and should be administered separately from Optional Vaccines. 

Core Vaccines can provide immune protection for 3 years or more. But optional vaccines like leptospirosis are said to be effective for only a year, some say less than a year. So it makes sense for these to be administered at different frequencies,  relevant to the duration of effectiveness  for each vaccine separately.

It is also desirable for lepto vaccines to be administered separately because when given as a combination vaccine, the chance for a vaccine reaction is higher, particularly in small dogs. The miniature dachshund in particular has been singled out in various discussions online as having higher chances of a reaction compared to other dogs.

Young adult, small-breed, neutered dogs that received multiple vaccines per visit are at greatest risk of a vaccine reaction and the lepto vaccine is the vaccine more likely to trigger a reaction.
– Dr Gwenda Lowe, veterinarian at Brighton Vet Care

Unfortunately, we were unable to follow the best practice that is recommended because…

In Singapore, Core Vaccinations were only available in combination with Leptospirosis Vaccines.

There was no option to administer these separately in Singapore currently, as far as I know after speaking with the vets I consulted/contacted.

Say WHUT?

“Vaccines in Singapore are mostly the 7-in-1s up to the 9-in-1s. I have not been able to source a local supplier for the leptospirosis vaccine so far. The import of vaccines is not straight forward because of the paperwork and approvals that need to be done,” Brighton Vet responded to me via email. “Suppliers need to see that there is substantial demand to justify the effort necessary for getting the separate vaccines approved for import into Singapore. If people are not asking for separate core vaccines from vets, and in turn the suppliers, there is no push to make separate core and lepto vaccines available for Singapore dogs. ” – Dr Gwenda Lowe, veterinarian at Brighton Vet Care

And therein lies the dilemma because… 

 

in Singapore, leptospirosis can and has caused severe illness and death in some dogs. It can also be spread to humans. This is why some vets advocate annual booster vaccination for our pet dogs.

 

The Dangers of Leptospirosis

Reaction to leptospirosis in dogs vary. Some infected dogs do not show any signs of illness, some have a mild and transient illness and recover spontaneously, while others develop severe illness and death, says vcahospitals.com

In severe cases, the lepto bacterial infection can damage the kidneys, liver, eyes, lungs and blood vessels. In recent years, acute kidney injury has been commonly caused by leptospirosis, according to merckvetmanual.com

The bacteria can also be spread to humans causing them to fall ill. Two days ago, the Star/Asia News Network reported that at least two people have died of leptospirosis after taking a dip in a waterfall or pond in Malaysia. [source]

And it is for these reasons that Donna’s neighbourhood vet strongly encourages their customers to vaccinate their dogs yearly with the combination vaccine that includes 4 serovars of leptospirosis.

Leptospirosis is completely preventable by annual vaccinations and this disease is still present in Singapore. Anywhere where there are rats present, (the rat is the main carrier), your dog or cat does not even need to consume the rat, all they need to do is consume or lick contaminated water where the rat had urinated. The bacteria lives in contaminated water for months.

Our most recent case, is an adult dog that only lapsed vaccinations for one year. This is not uncommon, especially when there are many misconceptions about vaccinations being harmful. The dog unfortunately did not survive, after suffering through multiple organ failure and internal bleeding into the lungs.

This disease is also notifiable in Singapore and is a zoonotic disease, infectious to humans. Given many areas in Singapore still have a rat problem, your pet could be exposed to contaminated water.
– The Animal Doctors, Sep 10 2015

So it seems, we are left with the difficult choice of either

1. over-vaccinating our dogs annually with core vaccines in order to get our dogs vaccinated for leptospirosis  OR
2. not vaccinating our dogs yearly, but understand that our dogs may run the risk of leptospirosis everytime they romp around in the muddy outdoors

How much of a risk is Leptospirosis to a dog like Donna?

Leptospirosis is spread through contact with water contaminated by urine from infected mammals, usually rats.

Exposure to leptospirosis can be reduced by preventing your dog from drinking from puddles of standing water or from swimming in lakes, streams, or other bodies of water that may be contaminated.
– vetstreet.com, Leptospirosis vaccine for dogs

There is no denying there is a rodent problem where we live.

I would say Donna’s risk level is higher than a chihuahua that stays indoors all the time but lower than a Labrador Retriever who may be tempted to jump into every body of water that he comes across at the park.

Yes, leptospirosis is seen in Singapore, and pets are most often infected when they are exposed to the carcasses or excrement of infected mammals, e.g. rats.
– Dr Gwenda Lowe, veterinarian at Brighton Vet Care

Dogs who spend most of their time outdoors in the yard, urban dogs that go to dog hashes and forested areas regularly, and also dogs who love to play in puddles or pools of standing water when walking outside may have higher chances of contracting leptospirosis through direct contact with contaminated water.

Donna spends most of her time indoors on weekdays when we are working. But she does get her daily walks in our area where there is a rodent population. And because she enjoys exploring the outdoors, we bring her to parks and outdoor green spaces regularly.

Traditionally, we think of lepto as a rural, large-dog problem. Often lepto spreads from wildlife urine and contaminated water. Dogs in an urban environment are at risk due to the exposure to rat urine and other wildlife exposure in parks and backyards.
– Serious disease prompt vet to improve lepto vaccines for dogs, post-gazette.com

The good thing is Donna doesn’t normally lick or drink from puddles, and she doesn’t have the urge to roll around in mud or where other critters left their waste material. She leaves dead animals alone.

But leptospira bacteria can remain infectious in the soil up to six months and like all dogs, Donna loves to wander about the grass where the rodents run around in our neighbourhood sniffing all the strange and wondrous scents there. And living in the hot and wet tropics, it is unavoidable that sometimes we walk on wet streets and grass, through puddles that collect after a rain.

Donna is not high-risk but some level of risk will always exist for Donna.

Does Vaccination really work for Leptospirosis?

As I was writing this post, I was thinking the vets I spoke with may have different views about vaccination but they agree that leptospirosis is present in Singapore. But, I actually don’t know any dogs who have been infected by leptospirosis before. Just how common or uncommon is leptospirosis locally?

So I went to the facebook group for Singapore Specials and put a question to the group asking if any of their dogs have been infected by leptospirosis before. Coincidentally, I noticed that 15 minutes earlier, somebody already posted a thread on leptospirosis.

Further conversation with Stephanie found that her dog was fully vaccinated but came down with leptospirosis anyway after a trip to the Green Corridor.

Lepto vaccines must have some degree of effectiveness for it to have become so widespread in use with the veterinary community. However, here are also some of the points often reiterated online, against the use of lepto vaccines:

1. Dogs that receive a 4-way vaccine can still develop leptospirosis. There are many serovars of leptospirosis, and in the case of Donna’s vaccination, the four serovars in her vaccination does not necessarily protect against the others. “Publications citing exposure risk in dogs highlight that approximately 10, of over 200, pathogenic serovars of leptospirosis are capable of infecting dogs worldwide”, wrote Richard B. Ford, DVM, MS, Diplomate ACVIM & ACVPM (Hon) North Carolina State University.
   • Significant increases of canine leptospirosis serovars Grippotyphosa, Pomona, and Bratislava have been reported since the early 1990s. – source
   • Infections caused by Leptospira interrogans serovars Canicola and Icterohaemorrhagiae have significantly decreased; this decline is largely attributed to routine vaccination. – source
   • Donna’s vaccination includes the serovars – Grippotyphosa, Pomona, Canicola and Icterohaemorrhagiae – but excludes Bratislava. These vaccines do not provide protection against other infecting serovars, such as Bratislava, which have been identified in the U.S. and confirmed in canine infections.
2. Leptospirosis is a bacterin, not a virus. Bacterial vaccinations do not provide long term immunity. This means the dog has to be re-vaccinated more frequently.
   • However, anecdotally, the leptospirosis vaccine is known to cause the most frequent and violent reactions, particularly in small dogs.
   • A 2014 report also found that infection risk can also be significantly higher for small dogs (<15kg) and terrier breeds. This may or may not argue for the decision to vaccinate, depending on how you look at it.

There really is no clear answer to this dilemma to vaccinate or not

But nothing in life is ever absolute. All we can ever do is learn as much as we can or want about the subject, consult with the expert (in this case a vet you trust) and make a decision from there.

I don’t think I’ll be comfortable knowing that I am over-vaccinating a dog for some viruses in order to protect them from another disease.  Neither am I comfortable with the fact that I have no choice to get Donna vaccinated with Core Vaccines and Leptospirosis separately when that is the recommended best practice.

This is Singapore. Why are we still living in the dark ages when other countries have progressed beyond?

I’m really surprised you’re not given the option of separate core vaccines in Singapore!
– Dr Joanna Paul, Creature Clinic, via email

Donna’s titer test results show that there is no need to re-vaccinate her this year after her 2014 shots. I have discussed her situation with both the vets at Brighton Vet and came away with the same conclusion that she doesn’t need to be re-vaccinated until her titer tests show otherwise.

Since Donna is not vaccinated for leptospirosis, we will just live life as normal but be vigilant in order to detect if and when Donna starts showing a combination of the many symptoms that can indicate a leptospirosis infection and arrange a vet visit immediately.

But, “the complexity of this disease and the difficulty of recognizing and testing for it makes the job of the veterinarian difficult”, writes Lawrence Gerson V.M.D. on post-gazette.com. So I can imagine, it would be even more difficult for a regular pet owner with no veterinary expertise. This disease is normally quite progressed when symptoms are noticed, according to Dogs Naturally Magazine.

I realise many online sources make leptospirosis sound like a very curable disease. While this may sometimes be the case, many times the pet is diagnosed so late in the course of the disease that the kidneys and liver are beyond rescue.
– Dr Gwenda Lowe, veterinarian at Brighton Vet Care

Regardless, I would keep this list of signs and symptoms handy to check back on from time to time in case of any concerns. This is because even if a dog is vaccinated with the lepto vaccines, he can still contract leptospirosis as shown by the Green Corridor case.

When symptoms do occur they usually appear between 4 and 12 days after exposure to the bacteria, and can include fever, muscle pain, vomiting and diarrhea, loss of appetite, lethargy, depression, and blood in the urine.

A lepto infection primarily affects the kidneys and liver, so in serious cases, there can be jaundice, which is a yellowing of the skin and mucous membranes. In dogs, it is usually most obvious in the whites of the eyes. Jaundice indicates the presence of hepatitis (liver inflammation) as a result of the destruction of liver cells by the bacteria.

Blood clotting problems can also develop, which can result in blood in the stool and bleeding from the tissues of the mouth. In rare cases, leptospirosis can also cause respiratory distress and acute pulmonary (lung) hemorrhage.

– Leptospirosis: Yes, you COULD get this disease from your dog, but…, healthypets.mercola.com

There are typical symptoms that veterinarians associate with leptospirosis. But because no two cases proceed exactly alike, not all of the typical signs are likely to be present in any one pet.

The most common signs are fever and depression. These pets are cold, shivery, and stiff. They may carry their tummies tucked up do to pain. Some drool and vomit and most loose their appetite. Fever causes many dogs to drink excessively.

– leptospirosis in your dog, 2nd chance.info

 

Whether to continue with yearly vaccination or not is a decision you need to make after reviewing the various factors relevant to your dog’s breed and lifestyle. And also how likely they are to put your dog at risk of exposure to leptospirosis or a vaccine reaction.

It is also helpful if you can consult with a vet you trust. That’s something I have to do as well. This is because the situation for every dog is unique. And different dogs will have different risk levels for contracting leptospirosis and different reactions to the leptospirosis vaccine.

Prevention of Leptospirosis

Dog owners can practice the following good habits to help lower the risk for exposure in regions where canine infections have been documented:
• Do not feed pets, including cats, outside because food attracts wildlife that serve as reservoirs for leptospirosis (eg, rats)
• Discourage pets, when feasible, from drinking from pools of standing ground water
• Vaccinate all dogs, regardless of breed, likely to swim in lakes/ ponds or have contact with wildlife.
– Today’s veterinary practice, March/April 2015, vol 5

 

Make a difference

Ask for separate core vaccines and leptospirosis vaccines at your regular vet. You may not get it right away, but if enough people keep asking for it, we may make a difference!

 

In summary

• Our dogs should receive Core Vaccinations for adenovirous, distemper, and parvovirus every 3 years or longer. This is the recommendation by the Global Veterinary Community.
• Optional Vaccines (e.g. for Kennel Cough and Leptospirosis) can require yearly booster shots.
• Core Vaccinations can be administered separately from Optional Vaccines, and should be because of their different duration of effectiveness.
• However in Singapore, Core Vaccinations are only available to us in combination with optional Leptospirosis Vaccines. There is no option to administer these separately.
• In Singapore, leptospirosis can and has caused severe illness and death in some dogs. It can also be spread to humans. This is why some vets advocate annual re-vaccination for our pet dogs.
• However giving the core and lepto vaccines at the same time (rather than separately), can increase the chance of a vaccine reaction, particularly in small dogs. The miniature dachshund in particular has been singled out in various discussions online as having higher chances of a reaction.
• Besides breed or size, the dog’s behaviour and living environment is also a factor in deciding whether lepto vaccines are needed. Leptospirosis is spread through contact with water contaminated by urine from infected mammals, usually rats. Dogs who live in or visit rainy tropical environments with a rodent population frequently and/or who love to play in puddles or pools of water during a walk will have higher chances of contracting Leptospirosis.
• There is debate on the effectiveness and the effective duration of leptospirosis vaccines, among other points, when it comes to considering the use of lepto vaccines on dogs.
• Whether to continue with yearly vaccination using the combination vaccines that include leptospirosis or not is a decision you need to make in consultation with your vet. This is because different dogs will have different risk levels for leptospirosis.
• Regardless of your final decision to vaccinate or not, it is recommended for pet owners to prevent your dogs from drinking from pools of standing water when outside, to avoid contracting the disease.

References

– WSAVA vaccination guidelines
– Vital vaccination: Canine Leptospirosis (still) an emerging infection?
– Recent advances in canine leptospirosis: focus on vaccine development
– Singapore may be on cusp of major rat over-population problem: Pest busters, The New Paper, Nov 2014
– A suspected cluster of leptospirosis in Singapore, 2011, MOH.gov.sg
– Protect your dog from leptospirosis – Mount Pleasant Vet Group
– Dog daycare issued with isolation order after spike in leptospirosis cases – channelnewsasia.com

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Thank you to Dr Jo Paul who helped to read my draft for this post. She writes at Creature Clinic.com. Articles with her input on my blog are tagged “creature-clinic” for easy reference.

 

Many thanks also to Dr Gwenda Lowe, veterinarian at Brighton Vet Care who really helped me to contextualise this post to Singapore better.!

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