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Journal of Feline Medicine and Surgery (2013) 15, 785808

SPECIAL ARTICLE

2013 AAFP Feline Vaccination


Advisory Panel Report

Rationale: This Report was developed by the Feline Vaccination Advisory Panel of the
American Association of Feline Practitioners (AAFP) to provide practical recommendations Margie A Scherk
to help clinicians select appropriate vaccination schedules for their feline patients based DVM Dip ABVP (Feline Practice)
on risk assessment. The recommendations rely on published data as much as possible, Advisory Panel Chair*
catsINK, Vancouver, BC, V5N 4Z4,
as well as consensus of a multidisciplinary panel of experts in immunology, infectious Canada
disease, internal medicine and clinical practice.
Richard B Ford
DVM MS Dip ACVIM DACVPM (Hon)
Department of Clinical Sciences, College
Introduction CONTENTS page of Veterinary Medicine, North Carolina
State University, Raleigh, NC 27607, USA
Introduction 785
Rosalind M Gaskell
The AAFP produced the first organization- Vaccination principles 786
BVSc PhD MRCVS
driven vaccination guidelines in 1998. These General information on types Small Animal Infectious Diseases Group,
were updated in 2000 and again in 2006.1 Each of feline vaccines 787 University of Liverpool,
Wirral, CH64 7TE, UK
version has offered a comprehensive review Risk/benefit assessment 788
Katrin Hartmann
of the literature and has provided recom - Vaccination recommendations
Dr Med Vet Dr Med Vet Habil
mendations for vaccine protocols based on for specific situations Dip ECVIM-CA
known science along with some extrapolation household pet cats 789 Medizinische Kleintierklinik,
Ludwig-Maximilians-Universitt,
between studies and between species when shelter-housed cats 791
Munich 80539, Germany
feline studies were not available. This Report cats in trapneuterreturn programs 793
Kate F Hurley
has used the same criteria. cats in breeding catteries 793
DVM MPVM
The practicing veterinarian is in the best Vaccine adverse events 794 Koret Shelter Medicine Program UC
Davis Center for Companion Animal
position to determine how to put these Pre-vaccination testing 795
Health, School of Veterinary Medicine,
Guidelines into practice for an individual Injectable vaccine administration University of California, Davis,
patient. The veterinarian should undertake a site recommendations 798 CA 95616, USA
clinical risk/benefit assessment for each ani- Legal considerations associated Michael R Lappin
mal and discuss recommended vaccination with vaccination 799 DVM PhD Dip ACVIM
Department of Clinical Sciences, College
schedules with the owner so that they can Abbreviations used in the Report and
of Veterinary Medicine and Biomedical
make an informed choice. The assessment Disease Information Fact Sheets 799 Sciences, Colorado State University,
Fort Collins, CO 80523, USA
should include discussion on the likelihood Appendix 1: Frequently asked questions
of exposure, the health and lifestyle of the General FAQs 802 Julie K Levy
DVM PhD Dip ACVIM
animal, and the risks related to vaccination. Shelter FAQs 803
Maddies Shelter Medicine Program,
The Advisory Panel recognizes that situa- Trapneuterreturn FAQs 804 College of Veterinary Medicine, University
tions differ in different countries, and that Adverse event FAQs 805 of Florida, Gainesville, FL 32608, USA

every country will have slightly different Appendix 2: Vaccinations for Your Cat Susan E Little
DVM Dip ABVP (Feline Practice)
issues and priorities; thus these Guidelines Pet Owner Guide 807
Bytown Cat Hospital, Ottawa,
will not necessarily be applicable to every See page 799 for list of Disease Information ON, K1K 1G6, Canada
country and the practitioner must interpret Fact Sheets and other resources available Shila K Nordone
accordingly. online as Supplementary Files. MS PhD
The three international panels that have Department of Molecular Biomedical
Sciences, College of Veterinary Medicine,
produced feline vaccination guidelines North Carolina State University,
(AAFP, World Small Animal Veterinary of whether vaccines are administered. Raleigh, NC 27607, USA
Association and European Advisory Board on While the optimal frequency of health Andrew H Sparkes
Cat Diseases) recommend that an annual examinations for cats is BVetMed PhD DipECVIM MRCVS
International Cat Care/ISFM,
health examination be performed irrespective unknown, it is generally High Street, Tisbury,
Wiltshire, SP3 6LD, UK
*Corresponding author:
Email: hypurr@aol.com
The AAFP welcomes
endorsement of these guide-
lines by the International
Society of Feline

785
Medicine (ISFM).
DOI: 10.1177/1098612X13500429
ISFM and AAFP 2013 JFMS CLINICAL PRACTICE
S P E C I A L A R T I C L E / 2013 AAFP feline vaccination guidelines

Vaccination principles
Whats new in this version
Vaccination plays an important role in the con-
Updated recommendations on vaccination trol of infectious diseases, both for an individ-
frequency and interval ual as well as for the cat population (ie, herd
Vaccination recommendations for specific health). Some vaccine antigens are also used to
situations lessen the potential for zoonotic spread of
Vaccinations for Your Cat Pet Owner Guide disease (eg, rabies). The benefits of routine and
Frequently asked questions widespread vaccination are clear: the inci-
Considerations and management options for dence of serious disease caused by highly
feline injection-site sarcoma risk reduction pathogenic organisms, such as feline parvo-
virus (panleukopenia), can be reduced in
At least once populations in which widespread vaccination
Information presented in depth in the
is practised. However, the level of protection
2006 AAFP Feline Vaccine Advisory Panel a year, as part
conferred by a particular vaccine in an individ-
Report1 that may be of interest to the
of a routine ual patient varies. The quality of vaccine-
reader includes:
induced immunity in any patient is influenced
Vaccine licensing health care by a complex interaction of factors unique to
Vaccine labels
program, the the individual patient, the patients environ-
Vaccination in kitten socialization ment, and the nature of the vaccine and
classes vaccination pathogen. Precisely predicting either the out-
Appendix 1: Certificate of Exemption come of vaccination or subsequent exposure to
from Rabies Vaccination needs of all a pathogen is difficult (or impossible) and,
Appendix 3: Vaccination documentation cats should be therefore, vaccination should never be offered
Appendix 4: Vaccine handling and as a guarantee of protection.
storage reassessed, The risk of infection and subsequent devel-
Appendix 5: Vaccine preparation opment of disease varies with a number of
Appendix 6: Vaccine administration tips
in conjunction factors including the age and health of the cat,
This material may be found in the with a magnitude of exposure to the infectious agent,
2006 Guidelines posted at: the pathogenicity of individual agents, the
http://www.catvets.com/guidelines/
comprehensive geographic prevalence of infection and the
vaccination history of the cat. Some of the fac-
practice-guidelines/feline-vaccination physical
tors that negatively affect an individual ani-
examination mals ability to respond to vaccination include
interference from maternally derived antibod-
and ies (MDA), congenital or acquired immuno-
accepted that healthy adult cats should be consultation. deficiency, concurrent disease or infection,
examined at least once a year. In the past, inadequate nutrition, immunosuppressive
annual veterinary visits were structured medications, chronic stress and an aging
around vaccinations as the primary focus. immune response. Additionally, some vaccinal
With the increasing body of knowledge about agents (eg, FPV) will induce a much stronger
duration of immunity (DOI) from vaccina- protective immune response than others (eg,
tions, their potential adverse effects, and the
increased awareness of pet owners about Figure 1 Kittens are more
these issues, it is clear that vaccination no
susceptible to infection Patient risk variables to
than adult cats are, and are
longer justifies the need for annual visits. a principal primary target take into consideration
population for vaccination.
Practitioners are encouraged Courtesy of Dr Deb Givin Age of cat
to help cat owners understand
Health of cat
the value of regular health care
Magnitude of exposure
and that it ideally should be
to agent
proactive rather than reactive.
Agent pathogenicity
A useful approach is for health
Geographic prevalence
care to be tailored to the vari-
History
ous feline life stages, which
MDA interference
improves early recognition of
Congenital or acquired
potential health-related issues
immunodeficiency
and can facilitate treatment.2
Immunosuppressive therapy
A Pet Owner Guide, dis-
Concurrent disease
cussing the risks and benefits
Nutritional status
of vaccination, is included as
Chronic stress
Appendix 2 (pages 807 and
Aging immune response
808).

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Va c c i n a t i o n c a t e g o r i e s
Core versus von-core
The Advisory Panel has revised which vaccines are risk/benefit assessment. The Advisory Panel believes
considered core and non-core, recognizing that antigens that rabies, feline leukemia virus (FeLV), feline
other than feline parvovirus, herpesvirus-1 and calicivirus immunodeficiency virus (FIV), Chlamydophila felis,
may not be required or available in all situations or in all Bordetella bronchiseptica, feline infectious peritonitis (FIP)
countries. The specific circumstances in which non-core and dermatophyte vaccines fall into this category.
vaccines may be appropriate vary considerably. Vaccination against rabies is essential in regions where
CORE VACCINES are those recommended for all cats. it is required by statute/law or where the virus is endemic.
The Advisory Panel recommends that feline panleukopenia The Advisory Panel recommends that all cats under 1 year
(FPV), feline herpesvirus-1 (FHV-1) and feline calicivirus of age be vaccinated against FeLV and receive a booster
(FCV) vaccines fall into this category. vaccination 1 year later. After 1 year of age, the need for
NON-CORE VACCINES should be administered to cats subsequent vaccination is determined by risk factors that
in specific risk categories on the basis of an individual the individual is exposed to.

The reader is referred to the section on risk/benefit assessment (pages 788789) and the accompanying Disease
Information Fact Sheets (details on page 799) for further specifics regarding each vaccine antigen.

feline herpesvirus [FHV-1]). As vaccine-afford- mental differences is necessary.


ed protection against both infection and dis- The following terminology is used through-
ease is thus variable and not absolute, exposure out these Guidelines to describe types of
to infected animals and infectious agents vaccines: inactivated (killed), modified-live
should be minimized, even after vaccination. (attenuated) and recombinant. The attributes of
Kittens are generally more susceptible to infec- each vaccine type are summarized in Table 1.
tions than adult cats are and typically develop Characteristics of vaccine types have been
more severe disease (Figure 1). Thus, they repre- reviewed as recently as 2011.3 All veterinary vac-
sent a principal primary target population for cines, prior to licensing, are subjected to testing
vaccination. As part of a routine health care pro- Overall for efficacy, safety, potency and purity. Testing
gram, the vaccination needs of all cats, including objectives methods may vary among different manufac-
adults, should be assessed at least once a year, in of vaccination turers and licensing authorities. While all
conjunction with a comprehensive physical To vaccinate
licensed vaccines need to meet minimum effica-
examination and consultation, modifying each cat only
cy standards, the level of protection induced can
vaccination recommendations as necessary on against infectious
vary depending on many factors, including the
the basis of altered risk/benefit ratio. agents to which
method used to manufacture the product. For
Vaccination is a medical procedure, and the it has a realistic
further information on licensing, readers should
decision to vaccinate, even with core vaccines risk of exposure
refer to the 2006 Guidelines (see box on page
(see box above), should be based on a To vaccinate
786) and to individual licensing authorities
risk/benefit assessment for each cat and for against infectious
(United States Department of Agriculture
each vaccine antigen. Vaccination may indeed agents that
[USDA]; Canadian Food Inspection Agency
be beneficial, but it is not innocuous, and the cause significant
[CFIA]; Veterinary Medicines Directorate
benefit of vaccinating an animal (eg, the disease
[VMD], Department for Environment, Food,
induction of clinically meaningful immunity) To vaccinate a
and Rural Affairs [DEFRA], UK; European
must be balanced against the risk of adverse cat only when the
Medicines Agency [EMA], EU).
events, likelihood of exposure and severity of potential benefits
The principal differences between inactivat-
disease. Where practical, every effort should outweigh the
ed, modified-live and recombinant vaccines
be made to ensure that cats are healthy prior potential risks
are discussed below.
to vaccination; however, concurrent illness To vaccinate
Inactivated vaccines Vaccinal pathogens
should not necessarily preclude vaccination. each cat no more
can be completely inactivated (ie, killed) by
The overall objectives of vaccination are frequently than
various means, eliminating risk of replication
shown on the right. necessary
post-inoculation or reversion to virulence.
To vaccinate the
For these reasons, inactivated vaccines have
General information on types of greatest number
historically been regarded as the safest
feline vaccines of cats possible
vaccines. However, the inclusion of a variety
in the population
of extraneous chemicals (stabilizers,
Vaccines, including different products at risk
preservatives), antibiotics, adjuvants and
licensed to protect against the same pathogen, To vaccinate
excipient proteins has been implicated as a
are not necessarily alike. Different vaccine appropriately to
cause of both acute and delayed adverse
technologies may directly influence efficacy, protect human/
reactions in cats.4
safety, DOI and route of administration of public health
Modified-live vaccines For some agents,
individual products. Awareness of funda - intact pathogens can be modified so that they

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Table 1 Examples of different types of feline vaccines and their attributes

Inactivated (killed) Modified-live (attenuated) Recombinant


Examples Panleukopenia, herpesvirus-1, Panleukopenia, herpesvirus-1, rRabies, rFeLV
calicivirus, FeLV, FIV, Chlamydophila, calicivirus, Chlamydophila,
rabies, dermatophytosis Bordetella bronchiseptica
Replication following Does not replicate (non-infectious) May replicate locally and in sites Does not replicate (non-infectious)
administration beyond the inoculation site (infectious)
Initial vaccination, in the Two initial doses are required, 34 Two initial doses are required, 34 rRabies: One dose is required.
absence of maternal antibody weeks apart. Protective immunity is weeks apart. Protective immunity is Protective immunity is expected to
expected within 710 days following expected within 710 days following develop by 28 days.
NB It is not practical to the second dose. the second dose rFeLV: Two initial doses are required,
determine the persistence of Rabies vaccine is the exception as 34 weeks apart. Protective
MDA for individual kittens; only one initial dose is required; immunity is expected within 710
vaccination until 16 weeks protective immunity is expected to days following the second dose
of age is advisable develop by 28 days
Route(s) of administration Injectable: SC or IM* Injectable: SC or IM* Injectable: SC
as stipulated by the Mucosal: Intranasal (IN)**
manufacturer
Adjuvanted Yes the majority Not required Some individual products contain
an adjuvant
Therapeutic indications Dermatophytosis (in some None None
European countries)
Reversion to virulence Not possible Theoretically possible, Not possible
but highly unlikely
NB Availability of different vaccines (type, antigen and route of administration) varies among countries
*The Advisory Panel recommends that when a vaccine is designed for either subcutaneous (SC) or intramuscular (IM) use, the SC route is used,
both for patient comfort as well as for earlier detection of injection-site sarcomas
**Several products (two FHV-1, FCV; one FPV, FHV-1, FCV; Bordetella; FIP) are licensed for intranasal administration, though availability varies
among countries
MDA = maternally derived antibodies, r = recombinant

retain the ability to replicate in the host and Specifically, questions need to be asked that
provoke an immune response, but not cause address the cats lifestyle as well as the
clinical disease. Altered pathogenicity lifestyle of any other cats in the same house-
effectively induces subclinical infection and hold. Queries should also be posed regarding
can result in a more rapid onset of immunity other sources of exposure, such as excursions
for some vaccine antigens than with outside the home, boarding and travel.
comparable inactivated vaccines.5,6 All
bacterial and viral vaccines licensed for Patient
mucosal (intranasal) administration are Age is an important element in assessing an
modified-live, as are a number of injectable individuals risk profile. Most infectious dis-
vaccines. eases are more prevalent in kittens, and kit-
Recombinant vaccines Discrete genetic tens less than 6 months old are generally more
sequences can be isolated from a pathogenic susceptible to infection and disease than adult
virus or bacterium that encode immunogenic cats are. Kittens, therefore, represent a princi-
proteins. These sequences can either be pal primary target population for vaccination.
recombined with the DNA of a live, MDA provide important protection for the
non-pathogenic virus, which can then be kitten, but may also interfere with, or neutral-
administered as a vaccine (vectored vaccine), ize, vaccines. As the level of MDA varies
or they may be inserted in bacterial plasmids among individuals, the age at which a kitten
to enable in vitro production of antigens may be able to respond to vaccination will
that can be harvested and purified for also vary, and in some cases may be 16 weeks
incorporation into a vaccine (ie, subunit or older. While information is available on the
vaccine). Examples of both types of vaccines variability of MDA as pertains to FHV-1, FCV
are licensed for use in veterinary medicine. and FPV, limited data is available for other
antigens; thus the role of MDA in interference
Risk/benefit assessment with vaccination against rabies, FeLV or other
pathogens is unknown. Stopping a vaccina-
In assessing the risk for an individual cat, tion course too early (when MDA are still
information about the cat, the environment interfering) is thought to be the single
and infectious agents to which the cat will be most common cause of vaccination failure in
realistically exposed needs to be considered. kittens.

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Patients environment Trapneuterreturn (TNR) and other special


Population density and opportunity for expo- Veterinarians situations are discussed on pages 791794.
sure to other cats (eg, whether the cat is free- Geographic distribution of infectious agents
roaming or has access to the outdoors) are
should may result in substantially different risks of
among the most critical issues affecting risk of reassess exposure for cats living in different areas
exposure to an infectious agent. Cats and kittens (eg, rabies). Questions regarding future travel
living in multiple-cat households and environ- risk factors for should be included in determining the risk
ments (eg, boarding, breeding, foster or shelter of exposure to specific infectious agents.
facilities) are likely to have a substantially high-
exposure to Periodic housing in boarding facilities, shel-
er risk of infection than are cats living indoors in infectious ters or breeding facilities or other multiple-cat
one- or two-cat households. Furthermore, the households also places cats at increased risk
introduction of new cats into a household poses disease at least of exposure to a variety of infectious agents,
a potential risk not only to the cat entering the once a year, although the risk will vary substantially
household, but also to the whole group because between different situations.
of possible exposure to new infectious agents. as changes in
The immunosuppressive effects of stress Infectious agent
inherent in the change of social demographics the health of Independent agent-associated variables, such
may also result in recrudescence and an the animal or as virulence, strain variation and mutation,
increased susceptibility to infection and disease. challenge dose and stability in the environ-
Conversely, cats that are naturally exposed to its lifestyle ment, influence the outcome of infection.
infectious agents after vaccination may have an These are difficult to assess objectively.
opportunity for natural boosting of immunity
may dictate
that may not be afforded to cats kept alone. modifications Recommendations for
Indoor cats generally have a low risk of vaccination of household
exposure to infectious agents, particularly in vaccinations pet cats
where the agent in question is only transmitted
by direct contact among cats. However, they
needed. Developing universal guidelines for vaccina-
may also be exposed to infection from other tion of household pet cats is complicated by
cats in the household (ie, subclinically infected the lack of a clear definition of what is, and
or carrier cats), or by indirect transmission of what is not, a pet cat. What follows are
pathogens brought in from outside on owners reasonable recommendations, based on
clothing, shoes, etc. In theory, strictly indoor scientific evidence and expert advice, appli-
cats may be more susceptible to developing cable to most cats presented to private
panleukopenia because they do not receive practitioners. Differences in cat population
boosting through the possibility of natural density, introduction of new cats, and
exposure. It is important to ask owners about exposure risk are dynamic variables that the
other exposure that indoor cats may have, veterinarian must take into consideration
such as supervised visits out of doors (eg, on when recommending any vaccine for any cat.
harness/leash, in the garden, etc), visiting It is advised that veterinarians reassess risk
other cats in an apartment building, balconies factors for exposure to infectious disease at
or roof gardens, visiting cats that belong to each visit (at least once a year), as changes in
other family members, and staying in boarding Figure 2 Pet cats that
factors such as the health of the animal or its
facilities. Fostering shelter cats alters the risk spend any time outdoors lifestyle may dictate changes to vaccination
for the resident cats, both through potential are at greater risk of needs.
exposure to many infectious
direct exposure to infectious agents as well as diseases compared with Table 2 summarizes vaccination recommen-
through stress-induced immunosuppression. indoor-only pet cats. dations for household pet cats.
Images courtesy of Dr Terry
Curtis (a), Dr Margie Scherk (b)
and Karen James (c)

a b c

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Table 2 Recommendations for vaccination of household pet cats

Initial vaccination
Vaccine Kittens Adults Revaccination Comments
(<16 weeks old) (16+ weeks old) (boosters)
Panleukopenia Administer the first Administer two Revaccinate 1 year after primary series; Modified-live and inactivated vaccines
+ herpesvirus-1 dose as early as doses, 34 weeks thereafter, boost every 3 years, lifelong are available for parenteral administration;
+ calicivirus 6 weeks of age, apart in some countries intranasal vaccines
(FPV, FHV-1, FCV) then every 34 are also available.
weeks until 1620 For cats going into boarding or another
Modified-live and weeks of age711 high exposure, stressful situation, a
inactivated. booster 710 days prior to boarding may
Recommended be warranted, particularly if the cat has
for all cats not been vaccinated in the preceding year
Feline leukemia Administer two Administer two Administer a single dose 1 year following Test first to verify FeLV antigen-negative
(FeLV) doses, 34 weeks doses, 34 weeks administration of the initial two-dose series. status.
apart, beginning as apart Results of several studies indicate that FeLV As kittens are more susceptible to
Inactivated and early as 8 weeks of vaccine-induced immunity persists for at progressive FeLV infection,17 and as the
recombinant age least 12 months following vaccination.1214 eventual environment into which a kitten
Thereafter, the Advisory Panel recommends will go can rarely be predicted with
revaccination every 2 years for cats at low certainty, the Advisory Panel
risk of infection and annually for cats at recommends routine FeLV vaccination
higher risk. A study by Jirjis et al suggests for all kittens up to and including 1 year
that DOI induced by some FeLV vaccines of age.18 At-risk adult cats should
may last for at least 2 years.15 Another continue to be vaccinated against FeLV
guidelines group (European Advisory Board
on Cat Diseases) recommends that for cats
older than 34 years of age, a booster
vaccination every 23 years is sufficient.16
(see accompanying Disease Information
Fact Sheet on FeLV details on page 799)
Rabies Administer a single Administer a single Administer a single dose 1 year following Where rabies vaccination is required, the
dose at not less dose the initial dose; then repeat annually (or frequency of vaccination may differ from
Inactivated and than 12 weeks/ every 3 years if using a vaccine licensed these recommendations based on local
recombinant. 3 months of age for this interval) statutes or requirements. Veterinarians
Necessary for all should be familiar with, and adhere to,
cats where legally local requirements
mandated or in an
endemic region
NB Unless otherwise stipulated, all parenteral vaccines should be administered by the subcutaneous route

Additional considerations when Offsetting this is the natural boosting of


vaccinating household pet cats immunity they may receive if they are
Because vaccination requirements and risk of exposed to infectious agents. Among outdoor
exposure to infectious agents vary among adult cats, exposure risk for rabies, FeLV and
household pet cats, individual vaccination FIV is generally higher than for indoor cats.
protocols will vary. The following recommen- In addition to the conventional vaccines
dations address some alternative situations recommended in Table 2, FIV vaccination
and offer insights on vaccination of pet cats could be considered for outdoor cats. (See
using non-core vaccines. accompanying Disease Information Fact
Vaccination of pet cats in indoor/outdoor Sheet on FIV details on page 799.)
householdsCats housed exclusively indoors Vaccination of pet cats entering boarding
generally do not require vaccination beyond facilities Although, in general, healthy adult
the aforementioned vaccines (ie, FPV, FHV-1, cats only require boosters to FPV, FHV-1, FCV
FCV FeLV, rabies). However, in multiple-cat vaccines every 3 years, an additional booster
households where some cats are housed 710 days prior to boarding may be
exclusively indoors, yet other cats are warranted (and may be required by some
permitted outside unmonitored, the entire catteries), particularly if the cat has not been
household may be at risk of exposure to vaccinated in the previous year. Boarding
additional agents. Veterinarians should may be stressful for a cat and also, depending
consider recommending vaccination of the on the cattery and the situation at the time,
entire household for selected diseases (eg, FeLV may lead to exposure to infectious agents.
rabies) if exposure risk is deemed significant. However, disease control measures vary
Pet cats that spend most (or all) of their between facilities, with many providing
lives outdoors are at greater risk of exposure individual housing, sneeze barriers and good
to most infectious diseases compared with hygiene, whereas others permit co-mingling
predominantly indoor pet cats (Figure 2). of cats, which will clearly facilitate disease

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transmission. In the event that kittens must Recommendations for vaccination


enter a boarding facility, it is recommended of shelter-housed cats
that they should have received at least two
doses of FPV, FHV-1, FCV vaccine, with the Generally, shelter-housed cats (Figure 3) can
last dose 710 days prior to entry. In addition, be considered to be at especially high risk
it is strongly recommended that kittens be of exposure to infectious disease. Endemic
isolated from the general population of adult disease, high rates of turnover, stress and
cats at all times while boarding. sustained exposure are contributing factors.
Vaccination during pregnancy and Vaccination in shelters should be limited to
lactationVaccination of pregnant or lactating those diseases that are likely to be transmitted
cats is generally not recommended. Whenever within the shelter itself. For diseases of con-
possible, queens should be vaccinated before cern in shelters (notably FPV and upper respi-
breeding. Vaccines are not evaluated for use in Vaccination in ratory infections), vaccines may be indicated
pregnant queens unless specifically stated on at an earlier age, and be administered at short-
the label. However, the benefits of vaccination
shelters should er intervals compared with schedules for
may outweigh the risks in endemic disease be limited to pet cats. Rapid onset of protection is critical;
situations. Modified-live FPV vaccines should therefore, administration of FPV, FHV-1, FCV
not be administered to pregnant queens as those diseases vaccines should be considered for all cats at
this has been associated with cerebellar the time of (or ideally, before) intake.
hypoplasia in the kittens.19 (For a more
that are likely Table 3 summarizes vaccination recommen-
comprehensive discussion, see to be dations for shelter-housed cats.
Recommendations for vaccination of cats
housed in breeding catteries, page 793.) transmitted Additional considerations when
Overdue for vaccination If the cat has within the vaccinating shelter-housed cats
been vaccinated previously and is overdue Bordetella bronchiseptica and
for revaccination (irrespective of the interval), shelter itself Chlamydophila felis vaccination The benefit
generally a single vaccination is all that is of routine vaccination of shelter-housed cats
required. If prior vaccination status is unknown, (notably FPV against these disease agents is limited. The
the cat should be treated as unvaccinated. and respiratory association between B bronchiseptica isolation
Bordetella bronchiseptica, Chlamydophila and disease in shelters is inconsistent3134 and
felis, FIP and FIV vaccination For infections). C felis is not commonly isolated from shelter
information on the use of these vaccines, cats with upper respiratory infection.31 These
see accompanying Disease Information Fact vaccines should only be considered if the
Sheets (details on page 799). pathogens have been demonstrated as a
Dermatophytosis vaccination At the time of current problem by laboratory diagnostics.
writing, a monovalent (Microsporum canis) and B bronchiseptica vaccination should also be
a multivalent (Microsporum and Trichophyton used where there is potential direct or
species) inactivated product are licensed for the indirect contact between cats and dogs on
prevention and treatment of dermatophytosis the same site, and the dogs have a recent or
in cats in some countries in Europe. None are current history of infectious respiratory
currently available in the USA or Canada. disease.
Limited evidence exists to support the safe use FIV and FIP vaccination Vaccination of
of these products as part of a comprehensive shelter-housed cats against these agents is not
treatment protocol in cats with proven infection, generally recommended.
but little evidence is available to support their Dermatophytosis vaccination See
use for prevention of infection.20,21 comments in the household pet cats section.

a b

Figure 3 Generally, cats


in shelters, whether
individually (a) or group (b)
housed, are at especially
high risk of exposure to
infectious disease. Images
courtesy of UC Davis Koret
Shelter Medicine Program
Team Members

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For diseases of concern in shelters, vaccines may be indicated at an earlier age


and administered at shorter intervals compared with schedules for pet cats.

Table 3 Recommendations for vaccination of shelter-housed cats

Vaccine First inoculation Subsequent inoculations Comments


Kittens Adults
Panleukopenia Administer a single Revaccinate Revaccinate Recent studies show that ML SC vaccination may provide better
+ herpesvirus-1 dose at intake or, every 23 once, 23 protection in the face of MDA than inactivated vaccines do, and may
+ calicivirus where possible, at weeks until weeks protect against illness even when cats are placed in a contaminated
(FPV, FHV-1, FCV) least 1 week prior 1620 weeks following environment soon after vaccination.22,23
to shelter entry. of age710 administration ML injectable or IN vaccines containing FPV should not be given to
Modified-live In kittens, of the initial kittens less than 4 weeks of age due to the risk of cerebellar hypoplasia19
(use of inactivated administer the first vaccine or clinical panleukopenia (see Appendix 1 [Shelter FAQs] Are there
vaccine is not dose as early as special considerations for vaccinating and housing very young kittens
generally 46 weeks of age in shelters?, page 803).
recommended For pregnant queens, risk of exposure versus risk of vaccination should
except where be balanced (see Appendix 1 [Shelter FAQs] Should pregnant queens in
panleukopenia risk shelters be vaccinated?, page 804).
is low). Inactivated multivalent calicivirus vaccines exist and may provide broader
Recommended for cross-protection against calicivirus infection than single strain vaccines.24,25
all cats Calicivirus may be more prevalent in shelters housing cats long term in
group settings;26,27 a multivalent vaccine may be preferable in this
context. If FCV disease occurs in fully vaccinated cats housed in groups,
changing to a product with a different vaccine strain(s) may be of benefit27
Intranasal Administer a single Revaccinate Revaccinate IN vaccination may result in onset of protection as early as 46 days
herpesvirus-1 dose at intake or, every 23 once, 23 post-inoculation.6,28
+ calicivirus where possible, at weeks until weeks Study results have been mixed* regarding reduction in risk for upper
(IN FHV-1, FCV) least 1 week prior 1620 weeks following respiratory tract infection in shelters from IN vaccination.29,30
to shelter entry. of age810 administration When using IN vaccination, use only products licensed and approved for
Modified-live In kittens, of the administration by this route.
If IN* vaccination is administer the first initial vaccine Transient, mild signs of upper respiratory infection may develop following
used for control of dose as early as administration of vaccine by the IN route
respiratory viruses, 46 weeks of age
all shelter cats over
46 weeks of age
should
simultaneously
receive a SC ML
FPV vaccine (with or
without respiratory
viral antigens)
Rabies Administer a single As for As for Necessary for all cats where legally mandated or in an endemic region.
dose at the time of household household For shelters adopting out virtually all cats, or where the length of stay is
Inactivated or entry or release pet cats pet cats commonly months or longer, rabies vaccine should be administered on
recombinant from the facility, (Table 2). (Table 2) intake. For shelters with shorter lengths of stay or where not all cats are
depending on risk NB Rabies adopted, rabies vaccination at the time of release is acceptable.
and length of stay vaccine If local regulations prohibit issuance of a rabies certificate for vaccines
should not be administered at the shelter, cats should receive a rabies vaccination from
administered a local veterinarian within 4 weeks of adoption
to kittens
less than
12 weeks/
3 months old
Feline leukemia Administer a single Revaccinate Revaccinate Unlike group-housed cats, risk of FeLV transmission is very low for
(FeLV) dose of vaccine at with a once, individually housed cats.
the time of intake if second dose 34 weeks FeLV vaccination is recommended for cats in long-term shelters or in
Inactivated or group-housed. If 23 weeks following group-housing of unrelated cats.
recombinant group (rather than later administration Vaccination is not a substitute for testing and segregation of infected cats
individual) housing of the initial
for kittens is used, vaccine
vaccinate as early
as 8 weeks of age
NB Unless otherwise stipulated, all parenteral vaccines should be administered by the subcutaneous (SC) route
*IN vaccination may provide protection against herpesvirus infection within 46 days, providing a hypothetical benefit in shelters.6,28 However, results
of IN vaccination for respiratory viruses in addition to parenteral vaccination in shelters are mixed, showing a modest reduction in upper respiratory
disease in one shelter29 but no difference in another.30 Although simultaneous use of IN and parenteral vaccination is not generally tested by
manufacturers and licensed for such use, there was no evidence in either study of reduced efficacy of the parenteral vaccine due to concurrent IN
vaccine administration.29,30 No information on safety was reported in these studies; however, there was no significant increase in respiratory signs
within the first 7 days of administration in cats receiving the IN with the parenteral vaccine versus the parenteral vaccine alone, suggesting that
vaccine-induced respiratory signs were not a significant concern. ML = modified-live, IN = intranasal, MDA = maternally derived antibodies

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Recommendations for a b
vaccination of cats in
trapneuterreturn programs

Most community cats (Figure 4, ie, free-roam-


ing unowned feral and stray cats) lack protec-
tive antibody titers against FPV, FHV-1 and
rabies.9,35 In one study, the vast majority of
feral cats vaccinated once at the time of TNR
surgery developed protective antibody titers
against FPV and FCV by the time they were
re-trapped for testing 23 months later,
regardless of whether inactivated or modi-
fied-live vaccines were used.35 In contrast,
only inactivated vaccines resulted in a high
rate of protective antibodies against FHV-1.35
In the same study, nearly all cats developed Figure 4 Community cats in TNR programs (a,b) should receive FPV, FHV-1, FCV and rabies
high antibody titers against rabies after a vaccines at the time of surgery. Images courtesy of International Cat Care

single dose of inactivated rabies vaccine.35


Vaccine licensing studies have demonstrated be housed together. Generally, the medical
34 year DOI following a single vaccine and vaccination history of the residents is well
administered to laboratory kittens. This known, but some diseases, such as upper res-
suggests that, while the first rabies vaccine piratory tract disease, may be endemic.
may only be recognized by regulatory agen- Vaccination programs should be limited to
cies as valid for a single year, it is likely that those diseases that are relevant to the cattery
vaccinated cats are protected for much longer. Vaccination and should be determined by analysis of risk
It is the recommendation of the Advisory factors. When assessing the level of disease
Panel that cats in TNR programs receive FPV, programs for risk in catteries, factors to consider include:
FHV-1, FCV and rabies vaccines at the time of breeding Rate of population turnover.
surgery. Population size and density.
catteries Number of litters/year (Figure 5).
Recommendations for Presence of endemic disease.
vaccination of cats housed should be Transmission of infectious diseases is facili-
in breeding catteries limited to those tated by group living, young kittens mixing
with older kittens and adults, contact during
Breeding catteries are variable in size, popula- diseases that mating, introduction of new cats, and move-
tion and the nature of available facilities. The ment of cats into and out of the cattery
cat population may number less than 10 indi-
are relevant, (eg, queens going to other catteries for breed-
viduals or more than 50. Cats of various ages determined ing, return of previously sold cats, travel for cat
and life stages are typically present and many shows or other exhibitions). Catteries assessed
catteries continue to house retired breeding by analysis of as low risk would be considered similar to pet
individuals that have been neutered. Some homes (Table 2), whereas catteries assessed as
also contain household pets that may or may
risk factors. high risk would be considered similar to shel-
not have access to outdoors. The facilities may ters (Table 3), pet stores, etc. In high-risk envi-
be sophisticated enough to allow for segrega- ronments, vaccines may be used at an earlier
tion of subpopulations or all individuals may age than in pet cats, particularly for control of
endemic upper respiratory tract disease.
In general, vaccination may be started at an
earlier age than in the pet cat population and
revaccination intervals may be shortened.
Breeders should be encouraged to work with
a veterinarian to develop a comprehensive
wellness program that includes appropriate
vaccinations for their specific situation.
Vaccination records should be kept for each
individual in the cattery that include all
Figure 5 The number of relevant information (eg, antigen, brand, date,
litters produced per year
in a breeding cattery is one
vaccination site, adverse events, etc).
of the key factors in Management and husbandry have an impor-
determining the level of
disease risk, and devising
tant impact on the health of individual cats in
an appropriate vaccination catteries. Relevant references and resources
program. Courtesy of
Betsy Gaither
should be consulted.36,37

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Table 4 Recommendations for vaccination of cats in breeding catteries

Vaccine Breeding adults Kittens Pregnant and lactating queens


Panleukopenia Low risk Low risk Whenever possible, queens should be
+ herpesvirus-1 As for household pet cats As for household pet cats (Table 2) vaccinated before breeding. However,
+ calicivirus (Table 2) benefits of vaccination may outweigh
(FPV, FHV-1, FCV) High risk risks in endemic disease situations.
High risk ML injectable vaccine starting at 46 weeks, Though not generally licensed for such
Recommended for Consider FHV-1 and FCV boosters every 23 weeks until 1620 weeks711 use, vaccines administered early in
all cats vaccination every 12 years. pregnancy may protect the queen and
Consider ML vaccines for Endemic upper respiratory tract disease provide enough MDA to protect kittens
rapid onset of protection. IN vaccination (FHV-1, FCV only) starting at 34 during the first weeks of life.38 No
Bi- or multivalent FCV weeks for rapid onset of protection,6 followed by increase in abortions or stillbirths was
vaccines may provide injectable ML FPV, FHV-1, FCV every 23 weeks documented in one study using an
broader cross-protection until 1620 weeks. The efficacy of administering inactivated vaccine in this way.39
than single strain one or two drops of IN vaccine per kitten instead ML injectable or IN vaccines containing
vaccines.24,25 of a full dose is unknown and is not recommended. FPV should not be given to kittens less
If FCV disease occurs in fully Avoid ML IN or injectable vaccines containing FPV than 4 weeks of age due to the risk of
vaccinated cats housed in in kittens less than 4 weeks of age due to the risk cerebellar hypoplasia19 or clinical
groups, changing to a of cerebellar hypoplasia19 or clinical panleukopenia. panleukopenia. For pregnant queens,
product with a different Kittens can be vaccinated around or at the time of risk of exposure versus risk of
vaccine strain(s) may be of spay/neuter surgery without compromising vaccination should be balanced.
benefit27 serologic response8 Queens may be vaccinated during
lactation if the benefits outweigh the risks
NB Unless otherwise stipulated, all parenteral vaccines should be administered by the subcutaneous route
ML = modified-live, IN = intranasal, MDA = maternally derived antibodies

Table 4 summarizes vaccination recommen- vaccination is considered safe for pregnant


dations for cats in breeding catteries. queens. However, in other countries,
datasheets advise that the vaccine should
Additional considerations when It is important not be used in pregnant or lactating queens
vaccinating cats in breeding catteries or in kittens less than 1 month of age.
FeLV and FIV vaccinationVaccination of to report FIP vaccination Vaccination of cats in
cats in breeding catteries against these agents breeding catteries against FIP is generally not
is not generally recommended. Vaccinate if any known recommended as there is insufficient evidence
necessary by analyzing risk, as for household or suspected that the vaccine induces clinically relevant
pet cats and kittens (Table 2). The retrovirus protection. (See accompanying Disease
status of all cats should be known: negative events Information Fact Sheet details on page 799.)
vaccination is not a substitute for testing and Dermatophytosis vaccination See earlier
isolation. Vaccination may be unnecessary if a
associated with comments in the household pet cats section
good testing program is in place and no cats vaccination, (page 791).
have access to the outdoors.13 If queens are
routinely sent to another cattery for breeding, recognizing Vaccine adverse events
vaccination of breeding queens may be
considered.
that a temporal Although the administration of biological
Rabies vaccination Cats in breeding relationship products can never be entirely free of risk, in
catteries in the USA must be vaccinated general currently available feline vaccines have
against rabies according to state regulations. between an an excellent safety record. It is important to
Elsewhere, vaccination against rabies is not event and report any known or suspected negative events
generally recommended. Vaccinate if associated with vaccination, recognizing that a
necessary by analyzing risk, as for household vaccine temporal relationship between an event and
pet cats and kittens (Table 2). vaccine administration does not necessarily
Bordetella bronchiseptica and administration imply causality. In the United States, veterinar-
Chlamydophila felis vaccinationThe benefit does not ians are requested to contact the manufacturer
of routine vaccination of cats in breeding (Veterinary Technical Services) of the vaccine(s)
catteries against these disease agents is necessarily considered to be involved; veterinarians may
limited. These vaccines should only be also report known or suspected adverse events
considered if the pathogens have been
imply causality. directly to the US Department of Agriculture.
demonstrated as a current problem by In other countries procedures may vary, but,
laboratory diagnostics. When used, the in general, veterinarians should contact the
primary series should be administered manufacturer and notify the appropriate regu-
according to the manufacturers instructions, latory agency to report a vaccine adverse event
with annual revaccination if the problem (eg, the Canadian Centre for Veterinary
remains endemic. In some countries, the Biologics [Canada]; the Veterinary Medicines
manufacturer states that Bordetella Directorate [UK]; the European Medicines

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Pre-vaccination testing

FeLV and FIV are immune. In fact, the protective immunity that develops fol-
The retrovirus status of all cats should be known and this is lowing FPV vaccination is expected to be sustained for several
important if administration of FeLV or FIV vaccines is being years. By contrast, serum antibody titers for FHV-1 and FCV may
considered.18 There is no recognized clinical not necessarily correlate well with protective
benefit in administering vaccine against the immunity and should not be used to predict
retrovirus a cat is infected with, nor are there
Because antibody protection in the future. Antibody titers to FeLV
any known harmful effects. However, when the titers may not and FIV do not correlate with immunity and
true retrovirus status of a vaccinated and should not be used to determine the need for
infected cat eventually becomes known, not reliably correlate vaccination. Although feline rabies titers can
having known the cats status before vaccina-
with, or predict, the be determined (by a certificated laboratory) in
tion could result in questions about failure to individual animals, a rabies titer is only an indi-
recommend testing before vaccination and degree of protection cation of serological response to vaccination.
vaccine efficacy. Rabies titers are not recognized as an index of
or susceptibility for immunity.
Use of serology an individual cat, In addition, the absence of significant levels
The use of serology (serum antibody titers) of antibody (a negative titer) is not necessari-
to assess protective immunity has been the Advisory Panel ly an indication of susceptibility. For example,
reviewed.1,40,41 It is important to be aware that a a previously vaccinated cat may, over time,
variety of methods (immunofluorescence assay,
recommends lose antibody. Immunologic memory, how-
ELISA, virus neutralization, haemagglutination employing defined ever, may prevail. In the event this individual is
inhibition, etc) are utilized to determine titers. exposed to a virulent virus, a rapid anamnestic
The methodology used may not be reported revaccination and protective response could result. In some
with the test results. Titer results in individual
cats determined at the same point in time,
intervals to assure diseases (eg, FHV-1), cell-mediated immunity is
important and a cat may be immune even
therefore, may vary depending on the method- protection. though no antibodies are detectable.
ology used. When electing to submit serum for Because antibody titers may not reliably
antibody titers, it needs to be appreciated that correlate with, or predict, the degree of protec-
a positive antibody titer result obtained on one day is not nec- tion or susceptibility for an individual cat, the Advisory Panel
essarily predictive of a positive titer at any point in the future. recommends employing defined revaccination intervals rather
In general, cats having a positive antibody titer against FPV than measuring antibody titers to assure protection.

Agency [EU]. (See Appendix 1 [Adverse Event cination were reported at a rate of 51.6/10,000
FAQs] on page 805 for specific reporting forms cats vaccinated (0.52%), with 92% of these
and instructions.) reactions occurring within the first 3 days.
The most commonly reported vaccine reac- Clinical signs described for 1699 of 2560 cats
tions are lethargy, anorexia and fever for a few with vaccination-associated adverse events
days after vaccination, or local inflammation at included lethargy ( pyrexia) in 54%, local
the site of injection.4,42,43 Rarely anaphylaxis is pain or swelling at the vaccine site (25%),
seen. Because vaccines are biologically active vomiting (10%), facial or periorbital edema
products, occasional adverse reactions associat- (6%) and generalized pruritus (2%). Death
ed with vaccination are inevitable. It should be was reported in four cats, and in at least two
recognized, however, that establishing causali- of these it was attributed to anaphylaxis.
ty is often difficult, especially if the suspected Although the vaccines used were predomi-
reaction is delayed (days or weeks).43 nantly from one manufacturer, no vaccine type
was found to be significantly more likely to
Prevalence and type of adverse reactions cause local reactions. Administration of multi-
Although post-vaccinal adverse events in cats valent FPV, FHV-1, FCV and Chlamydophila
are considered rare, the true prevalence is vaccines was significantly more likely to be
likely to be underestimated due to under- associated with lethargy ( pyrexia) than
reporting by both veterinarians and owners.44 administration of vaccines without the
In the most substantial survey to date, adverse Chlamydophila component. The risk of an
reactions were reported for all cats presented adverse reaction was greatest in cats around 1
to Banfield Pet Hospitals in the United States year of age and/or increased as the number of
between 2002 and 2005.4 During this period, vaccines administered concurrently increased.4
more than 1.25 million doses of various vac- In another extensive study specifically investi-
cines were administered to nearly 0.5 million gating local post-vaccine reactions, a preva-
cats. Adverse reactions within 30 days of vac- lence of 0.23% was reported.45 Previous large

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nation. Rarely it may represent a form of type


Suggested approach to the treatment of anaphylaxis III reaction, but it is mainly due to co-infection
with field virus or vaccine virus itself.50,51
Place intravenous catheter (See Appendix 1 [General FAQs] What is the
Administer epinephrine (adrenaline): 0.1 ml of a 1:1000 dilution IV cause of lameness occasionally seen after FCV
Administer 2030 ml/kg balanced isotonic crystalloid by slow infusion vaccination?, page 802.)
over 10 mins
Provide oxygen Update on feline injection-site sarcomas
Administer an H1-blocker: eg, diphenhydramine, 2 mg/kg IM or IV (FISS)
Administer soluble glucocorticoid: eg, methylprednisolone sodium Vaccine-associated sarcoma was first recog-
succinate, 30 mg/kg IV nized as an issue in cats in the early 1990s.
While initial studies suggested a risk of sarco-
ma development in around 2/10,000 doses of
vaccine administered,52 which increased to
studies have suggested adverse vaccine reac- 1336/10,000 doses in other studies,5355 cur-
tion rates of around 13%,4648 but some varia- rent estimates based on larger epidemiologic
tion in prevalence can be expected with the use studies (published between 2002 and
of different products, administration of multi- 20074,45,56) suggest that the risk of sarcoma
ple vaccines at the same appointment, and development following vaccination is actually
surveillance methods. very low (probably well below 1/10,000 doses
of vaccine).4,45
Hypersensitivity reactions Although initial reports linked develop-
Anaphylaxis and allergic reactions ment of sarcomas at vaccination sites with the
Anaphylaxis is perhaps the best characterized use of inactivated rabies57 or FeLV vaccines,52
immune-mediated hypersensitivity (type I) and aluminum-based adjuvants, more recent
reaction to vaccination, but it is rare (approxi- studies found no relationship between vac-
mately 15/10,000 vaccines).4,46 In cats it may cine type, brand or use of inactivated versus
manifest as vomiting, diarrhea, respiratory modified-live vaccines and the risk of subse-
distress, facial or generalized pruritus, facial quent sarcoma formation.56,58,59 The impact of
swelling and collapse.1,43,49 using the canarypox-vectored rabies vaccine
A careful risk assessment is needed when is still unclear. One retrospective study of
considering the revaccination of cats with a histopathology samples showed no reduction
history of anaphylaxis. In cats that have in the prevalence of FISS after the introduction
experienced an allergic reaction with true of this vaccine; however, the types of vaccine
anaphylaxis, revaccination should usually be used were not reported.58 In a recently pub-
avoided. Vaccine excipients (inactive ingredi- lished case control study it was suggested that
ents) are thought to cause most type I hyper- there may be a lower risk of inducing sarco-
sensitivity reactions.4 Hence, where revaccina- mas with this vaccine than with other rabies
tion is considered necessary, using a different vaccines.59 Many of these studies have also
vaccine formulation and premedicating with clearly shown that injections other than vac-
Figure 6 While vaccines
an antihistamine and glucocorticoids 2030 are not uniquely implicated cines also have the ability to induce sarcoma
mins prior to vaccine administration is recom- in sarcoma formation, there formation.
mended, followed by close observation of the are certain actions that
can be taken to reduce No studies have been published that define
patient for several hours.1,4 the risk of FISS, as objective methods for reducing the risk of
Depending on geographic location, the summarized in Table 5.
Courtesy of Albert Lloret
FISS in individual
requirement to vaccinate cats for rabies may cats presented for
take precedence over medical considerations. routine vaccination.
Veterinarians are urged to contact the appro- Based on our current
priate authorities to determine what the local understanding of
status is when concerns arise and whether the this problem, it is
individual may be excused from vaccination. likely that vaccines
(See also 2006 Guidelines, Appendix 1: are not uniquely
Certificate of Exemption from Rabies implicated in the
Vaccination details on page 786.) development of
injection site sarco-
Other reactions mas in cats.56,60 FISS
While other forms of hypersensitivity reac- risk following vacci-
tions (types II, III and IV) almost certainly nation likely results
occur in cats after vaccination, these are rarely from a complex
documented. Some forms of local reaction interaction of mul-
probably reflect type IV reactions. Poly - tiple extrinsic (eg,
arthritis is occasionally seen after FCV vacci- frequency and num-

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Table 5 Summary of considerations and management options for FISS risk reduction

Action suggested Objective Comments


Recommend/administer vaccines To avoid unnecessary Studies have suggested that the risk of FISS increases as the number of
on the basis of reasonable risk for vaccination of cats vaccines received over time increases37,6264
exposure to the infectious pathogen
Administer vaccines only as To avoid unnecessary Administer FPV, FHV-1, FCV no more often than every 3 years,
frequently as needed to provide vaccination of cats except in high-risk situations1,63
protective immunity
Administer parenteral feline To facilitate early detection Vaccine administered by the IM route does not reduce the risk of
vaccines by the SC route only of tumor tumorigenesis and may delay the detection of a mass located within
muscle (vs skin). It is recommended that all parenteral vaccines be
administered by the SC route65
Use recommended vaccination sites To facilitate complete tumor See vaccination site recommendations on page 798
removal by limb amputation in
the event that FISS develops
Consider vaccine type To reduce the risk of chronic The role of adjuvants (including those containing aluminum) and local
local inflammation at the inflammation in the pathogenesis of FISS is not clear.52,57, 61,6468 Both
injection site, which may adjuvanted and non-adjuvanted vaccines induce local inflammation,
occur in some cats56 although the magnitude and type of inflammation varies among vaccines,
adjuvants and individual cats. However, some authors recommend
considering non-adjuvanted vaccines to try to reduce local inflammation61
Biopsy of a post-vaccination lump: To establish the presence or Perform an incisional (vs excisional) biopsy if a lump:
the 3-2-1 rule absence of malignant tumor (a) persists for 3 months or longer after injection; or,
formation as early as possible (b) ever becomes larger than 2 cm in diameter; or,
(c) continues to increase in size 1 month after injection58
Perform additional assessment To evaluate the feasibility of Tumors are locally aggressive; thoracic metastasis occurs in over 25%
pre-surgically when FISS is attempting definitive treatment of cases. Thorough pre-surgical evaluation of individual cases, including
confirmed physical and laboratory assessment, thoracic radiography and other
imaging as indicated, is recommended prior to surgical excision63,69,70
Remove tumor surgically To completely excise the tumor Surgery offers the best opportunity for cure. Radical surgery is usually
required to prevent recurrence. Local excision (lumpectomy) of FISS is not
recommended. In addition to surgery, radiation therapy and/or chemotherapy
may be recommended based on consultation with an oncologist7175

FISS = feline injection-site sarcoma, SC = subcutaneous, IM = intramuscular

ber of vaccines administered over time, com- also other factors that may influence the
position of the injected product, etc) and choice of live versus inactivated vaccines
intrinsic factors (eg, genetic predisposition, (see Table 6 and Appendix 1 [General FAQs],
tissue response following injection, etc). The
presumed relationship between types of vac-
cine, inflammation at the site of vaccination61 Table 6 Indications for the use of inactivated vaccines in cats
and subsequent FISS development appears
complex at best and, if involved, is likely only Indication Objective Comment
one among many factors that contribute to Vaccination of To avoid the risk of fetal/ ML FPV may replicate in
FISS development. pregnant queens neonatal infection with cerebellar tissue of fetal and/or
Table 5 provides a brief review of consider- ML FPV neonatal kittens, leading to
ations and management options for the reduc- clinical signs associated with
cerebellar hypoplasia19
tion of FISS risk, taken from current publica-
Vaccination of cats To avoid unlikely, but The risks associated with
tions. None of these suggestions are known to known to be retrovirus potential consequences administering ML vaccine virus
prevent or cure FISS. positive of exposing an immune- to an immune-suppressed
When considering vaccine type, the suppressed cat to ML, (retrovirus-positive) cat are
Advisory Panel recommends that the follow- replicating vaccine virus unknown
ing be taken into consideration. Recent stud- High-density housing To avoid the risk of ML FHV-1 and FCV vaccine virus,
ies demonstrate that all vaccines carry some environments where accidental or inadvertent if inadvertently aerosolized or
upper respiratory oral/nasal exposure to inoculated by the oral or nasal
risk of inducing FISS, as do at least some other infections are not ML FHV-1 and FCV routes, may cause upper
injectable products. Although current infor- known to be present vaccines respiratory signs associated
mation as outlined above does not clearly with vaccine virus replication
on mucosal surfaces
show differences in risk of FISS development
between modified-live and inactivated vac- Rabies vaccine: when To provide licensed The only rabies vaccines currently
3-year DOI is indicated 3-year DOI licensed to provide 3-year DOI
cines, some Advisory Panel members consid- or required are inactivated vaccines
er that, on balance, risk might be mitigated
by the use of modified-live vaccines. There are ML = modified-live, DOI = duration of immunity

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page 803). Overall, however, the Advisory Post-vaccination monitoring


Panel concluded that, at the current time, The Advisory Panel recommends that clini-
there is insufficient information to make cians and their staff instruct clients to monitor
definitive recommendations to use particular the vaccine site for swelling or lumps in order
vaccine types to reduce the risk of FISS. to detect potential sarcomas while they may
still be removed successfully. Biopsy of any
mass present is warranted if it (a) remains pres-
ent 3 months after vaccination; (b) is larger than

Injectable vaccine administration


Vaccination site recommendations
There is a lack of clinical information to make evidence-based The Advisory Panel recommends, as in the 2006 Guidelines,
vaccine site recommendations. The majority of safety and effica- that veterinarians administer:
cy data comes from licensing studies in which vaccines are FPV, FHV-1, FCV vaccines below the right elbow (Figure 7).
administered subcutaneously in the interscapular region. Due to FeLV vaccines below the left stifle (Figure 8).
concerns of potential sarcoma development, practitioners may Rabies vaccines below the right stifle (Figure 9).
consider giving vaccines in other locations. Current research Vaccines should be administered as low on the leg as possi-
indicates that radical surgical resection of injection-site sarco- ble. Caution is warranted when vaccinating cats resting in a
mas, including margins of 5 cm when possible, is associated crouched position as this may result in inadvertent injection of
with the highest response rate and long-term survival.75 A 2009 the skin fold of the flank. Veterinarians should note that data on
paper reported an increase in lateral abdominal injection-site the safety and efficacy of administering vaccines in very distal
sarcomas since the publication of the Vaccine-Associated Feline limb locations are lacking. Figure 10 shows recommended
Sarcoma Task Force vaccination recommendations in 1996.76 vaccination sites, as well as sites to avoid.

Figure 7 Administration of FPV, FHV-1, FCV vaccine subcutaneously below Figure 8 Administration of FeLV vaccine subcutaneously below the left
the right elbow. Courtesy of Dr Susan Little stifle. Courtesy Dr Susan Little

x
x
x

Figure 9 Administration of rabies vaccine subcutaneously below the right Figure 10 Regions indicated in green are recommended. Those in red are
stifle. Courtesy Dr Susan Little key sites that should be avoided. Image iStockphoto.com/GlobalP

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Rabies vaccination of cats


Abbreviations used in the Report and Disease Information Where rabies vaccination of cats is required,
Fact Sheets veterinarians may not have discretion to vary
from the manufacturers recommendations or
AAFP American Association of Feline Practitioners from requirements set forth by regulatory agen-
ADE Antibody-dependent enhancement cies. Rabies vaccination requirements vary from
APHIS Animal and Plant Health Inspection Service country to country and can vary significantly
CPV-2 Canine parvovirus type 2 within individual countries. In locations where
CVB Center for Veterinary Biologics feline rabies vaccination is required by law, vet-
DOI Duration of immunity erinarians are obligated to be familiar with and
ELISA Enzyme-linked immunosorbent assay follow legal requirements when administering
EMA European Medicines Agency rabies vaccines. Rabies vaccination recommen-
FCoV Feline coronavirus dations contained in these Guidelines do not
FCV Feline calicivirus constitute vaccination requirements.
FECV Feline enteric coronavirus
FeLV Feline leukemia virus
Medical record documentation
FHV-1 Feline herpesvirus-1
of vaccination
FIP Feline infectious peritonitis
At the time of vaccine administration, the fol-
FIPV Feline infectious peritonitis virus
lowing information should be recorded in the
FISS Feline injection-site sarcoma
patients permanent medical record:
FIV Feline immunodeficiency virus
Vaccine(s) recommended for this patient.
FPV Feline parvovirus
Date of vaccine administration.
FPV, FHV-1, FCV Three-way panleukopenia + herpesvirus 1 + calicivirus
Identity (name, initials or code) of the
vaccine (often referred to in North America as FVRCP)
person administering the vaccine(s).
IA Inactivated [vaccine] (also known as killed)
Vaccine name, lot or serial number,
IM Intramuscular
IN Intranasal
expiration date, and manufacturer of
ISFM International Society of Feline Medicine
vaccine(s) actually administered.
IV Intravenous
Site and route of vaccine administration.
MDA Maternally derived antibodies Concurrent medications/therapy.
ML Modified-live [vaccine] (also known as attenuated) Recommendations for future vaccinations.
r When preceding a vaccine, denotes a recombinant vaccine Adverse events should be recorded in a
(eg, rRabies) manner that will clearly alert all staff mem-
SARSS Suspected Adverse Reaction Surveillance Scheme bers during future visits. Risks and benefits
SC Subcutaneous of vaccination should be discussed with the
TNR Trapneuterreturn owner so that they can make an informed
URD Upper respiratory tract disease choice. Consent should be documented in
USDA United States Department of Agriculture the medical record to demonstrate that rele-
VMD Veterinary Medicines Directorate vant information was provided to the client
VS-FCV Virulent systemic feline calicivirus and that the client authorized the procedure.

2 cm in diameter; or (c) is increasing in size


1 month after vaccination (the 3-2-1 rule
see Table 5). It is recommended that multiple
needle biopsies or an incisional wedge biopsy DISEASE INFORMATION
are obtained to reduce the risk of harvesting FACT SHEETS SUPPLEMENTARY FILES
non-representative biopsy material and to min- Feline herpesvirus 1 Fact Sheets accompanying the
imize the risk of tracking tumor cells outside of Feline calicivirus 2013 AAFP Feline Vaccination Advisory
Panel Report are available,
the future surgical field. Feline panleukopenia
together with the Pet Owner Guide
Rabies
included in Appendix 2, at
Legal considerations associated Feline leukemia virus http://jfms.com
with vaccination Feline immunodeficiency virus DOI: 10.1177/1098612X13495235
Feline infectious peritonitis
Veterinarians in most countries are permitted Chlamydophila felis
to use professional judgment in the selection Bordetella bronchiseptica
and use of licensed vaccines. Reference to these
Guidelines, therefore, is appropriate when
developing vaccination protocols for individ- GENERAL INFORMATION
ual patients even though the guidance may FACT SHEET PET OWNER GUIDE
vary from the manufacturers label recommen- A brief review of the immune (APPENDIX 2)
dations or data sheet (eg, annual revaccination response to vaccination Vaccinations for Your Cat
vs triennial revaccination for core vaccines).

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Acknowledgements and outcome of FIV infection. Vet Immunol Immunopathol 1995; 46: 127137.
13 Hoover EA, Mullins JI, Chu HJ and Wasmoen TL. Efficacy of an inactivated
The AAFP would like to thank Boehringer Ingelheim for its sponsorship feline leukemia virus vaccine. AIDS Res Hum Retroviruses 1996; 12: 379383.
of these Guidelines and for its commitment to helping the veterinary 14 Harbour DA, Gunn-Moore DA, Gruffydd-Jones TJ, Caney SM, Bradshaw
community develop projects that will improve the lives of cats. J, Jarrett O, et al. Protection against oronasal challenge with virulent feline
Sponsorship does not imply endorsement of the sponsors products or leukaemia virus lasts for at least 12 months following a primary course of
services by the Association. The content of these Guidelines has been immunisation with Leukocell 2 vaccine. Vaccine 2002; 20: 28662872.
solely created by the Feline Vaccination Advisory Panel members. The 15 Jirjis F, Davis T, Lane J, Carritt K, Sweeney D, Williams J, et al. Protection
sponsor has provided financial support directly to the Association and against feline leukemia virus challenge for at least 2 years after vaccination
has had no role in the creation of content. with an inactivated feline leukemia virus vaccine. Vet Ther 2010; 11: E16.
16 Lutz H, Addie D, Belak S, Boucraut-Baralon C, Egberink H, Frymus T,
Conflict of interest et al. Feline leukaemia ABCD guidelines on prevention and
management. J Feline Med Surg 2009; 11: 565574.
RBF consults with IDEXX Laboratories (Westbrook, ME), Merial Ltd 17 Hoover EA, Olsen RG, Hardy WD Jr, Schaller JP and Mathes LE. Feline
(Duluth, GA) and Elanco (Greenfield, IN). RMG is a co-investigator leukemia virus infection: age-related variation in response of cats to
on a project funded by MSD. KFH runs a shelter medicine residency experimental infection. J Natl Cancer Inst 1976; 57: 365369.
program at UC Davis sponsored by Boehringer Ingelheim. JKL has 18 Levy J, Crawford C, Hartmann K, Hofmann-Lehmann R, Little S, Sundahl
worked with various pharmaceutical, vaccine and diagnostic test E, et al. 2008 American Association of Feline Practitioners feline retro-
companies over the years to complete research studies, student and virus management guidelines. J Feline Med Surg 2008; 10: 300316.
house officer training, to present at veterinary conferences, and to serve 19 Sharp NJ, Davis BJ, Guy JS, Cullen JM, Steingold SF and Kornegay JN.
on expert advisory panels. Hydranencephaly and cerebellar hypoplasia in two kittens attributed to
intrauterine parvovirus infection. J Comp Pathol 1999; 121: 3953.
References 20 Westhoff D, Orveillon FX, Farnow D, Kls MC and Elbers K. Safety of a
non-adjuvanted therapeutic vaccine for the treatment of feline der-
1 Richards JR, Elston TH, Ford RB, Gaskell RM, Hartmann K, Hurley KF, matophytosis. Vet Rec 2010; 167: 899903.
et al. The 2006 American Association of Feline Practitioners Feline 21 Westhoff DK, Kloes M-C, Orveillon FX, Farnow D, Elbers K and Mueller
Vaccine Advisory Panel Report. J Am Vet Med Assoc 2006; 229: 14051441. RS. Treatment of feline dermatophytosis with an inactivated fungal
2 Vogt AH, Rodan I, Brown M, Brown S, Buffington CAT, LaRue Forman vaccine. Open Mycol J 2010; 4: 1017.
MJ, et al. AAFPAAHA: Feline life stage guidelines. J Feline Med Surg 22 DiGangi BA, Levy JK, Griffin B, Reese MJ, Dingman PA, Tucker SJ, et al.
2010; 12: 4354. Effects of maternally-derived antibodies on serologic responses to
3 Day MJ and Schultz RD. Vaccination. In: Veterinary immunology princi- vaccination in kittens. J Feline Med Surg 2012; 14: 118123.
ples and practice. London: Mason Publishing, 2011, pp 192202. 23 Brun A, Chappuis G, Precausta P and Terre J. Immunisation against
4 Moore GE, DeSantis-Kerr AC, Guptill LF, Glickman NW, Lewis HB and panleukopenia: early development of immunity. Comp Immunol
Glickman LT. Adverse events after vaccine administration in cats: Microbiol Infect Dis 1979; 1: 335339.
2560 cases (20022005). J Am Vet Med Assoc 2007; 231: 94100. 24 Poulet H, Jas D, Lemeter C, Coupier C and Brunet S. Efficacy of a
5 Lappin MR, Veir J and Hawley J. Feline panleukopenia virus, feline her- bivalent inactivated non-adjuvanted feline calicivirus vaccine: relation
pesvirus-1, and feline calicivirus antibody responses in seronegative between in vitro cross-neutralization and heterologous protection in
specific pathogen-free cats after a single administration of two differ- vivo. Vaccine 2008; 26: 36473654.
ent modified live FVRCP vaccines. J Feline Med Surg 2009; 11: 159162. 25 Huang C, Hess J, Gill M and Hustead D. A dual-strain feline calicivirus vac-
6 Lappin MR, Sebring RW, Porter M, Radecki SJ and Veir J. Effects of a cine stimulates broader cross-neutralization antibodies than a single-strain
single dose of an intranasal feline herpesvirus 1, calicivirus, and pan- vaccine and lessens clinical signs in vaccinated cats when challenged with
leukopenia vaccine on clinical signs and virus shedding after challenge a homologous feline calicivirus strain associated with virulent systemic
with virulent feline herpesvirus 1. J Feline Med Surg 2006; 8: 158163. disease. J Feline Med Surg 2010; 12: 129137.
7 Kruse BD, Unterer S, Horlacher K, Sauter-Louis C and Hartmann K. 26 McManus CM, Levy JK, Andersen LA, et al. Prevalence of upper respirato-
Prognostic factors in cats with feline panleukopenia. J Vet Intern Med ry pathogens in four management models for unowned cats in the
2010; 24: 12711276. Southeast United States [abstract]. J Vet Intern Med 2011; 25: 707.
8 Reese MJ, Patterson EV, Tucker SJ, Dubovi EJ, Davis RD, Crawford PC, 27 Radford AD, Addie D, Belak S, Boucraut-Baralon C, Egberink H, Frymus
et al. Effects of anesthesia and surgery on serologic responses to vacci- T, et al. Feline calicivirus infection: ABCD guidelines on prevention and
nation in kittens. J Am Vet Med Assoc 2008; 233: 116121. management. J Feline Med Surg 2009; 11: 556564.
9 DiGangi BA, Gray LK, Levy JK, Dubovi EJ and Tucker SJ. Detection of 28 Cocker FM, Newby TJ, Gaskell RM, Evans PA, Gaskell CJ, Stokes CR, et
protective antibody titers against feline panleukopenia virus, feline al. Responses of cats to nasal vaccination with a live, modified feline
herpesvirus-1, and feline calicivirus in shelter cats using a point-of- herpesvirus type 1. Res Vet Sci 1986; 41: 323330.
care ELISA. J Feline Med Surg 2011; 13: 912918. 29 Edinboro C, Janowitz L, Guptill-Yoran L and Glickman RT. A clinical trial of
10 Dawson S, Willoughby K, Gaskell RM, Wood G and Chalmers WS. intranasal and subcutaneous vaccines to prevent upper respiratory infec-
A field trial to assess the effect of vaccination against feline her- tion in cats at an animal shelter. Feline Pract 1999; 27: 711.
pesvirus, feline calicivirus and feline panleucopenia virus in 6-week- 30 Newbury SP. A placebo controlled field trial of an intranasal vaccine for
old kittens. J Feline Med Surg 2001; 3: 1722. feline calicivirus and feline herpesvirus to prevent clinical signs of feline
11 Jakel V, Cussler K, Hanschmann KM, Truyen U, Konig M, Kamphuis E, infectious respiratory disease complex in an animal shelter. Proceedings
et al. Vaccination against feline panleukopenia: implications from a of the 88th Conference of Research Workers in Animal Diseases, 2007.
field study in kittens. BMC Vet Res 2012; 8: 62. 31 Bannasch M and Foley J. Epidemiologic evaluation of multiple respirato-
12 Hofmann-Lehmann R, Holznagel E, Aubert A, Ossent P, Reinacher M and Lutz ry pathogens in cats in animal shelters. J Feline Med Surg 2005; 7: 109119.
H. Recombinant FeLV vaccine: long-term protection and effect on course 32 Veir JK, Ruch-Gallie R, Spindel ME and Lappin MR. Prevalence of select-

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ed infectious organisms and comparison of two anatomic sampling 55 Macy D and Hendrick M. The potential role of inflammation in the
sites in shelter cats with upper respiratory tract disease. J Feline Med development of postvaccinal sarcomas in cats. Vet Clin North Am Small
Surg 2008; 10: 551557. Anim Pract 1996; 26: 103109.
33 Binns S, Dawson S, Speakman A and Lappin MR. Prevalence and risk factors 56 Kass PH, Spangler WL, Hendrick MJ, McGill LD, Esplin DG, Lester S,
for feline Bordetella bronchiseptica infection. Vet Rec 1999; 144. et al. Multicenter case-control study of risk factors associated with
34 Spindel ME, Veir JK, Radecki SV and Lappin MR. Evaluation of prado - development of vaccine-associated sarcomas in cats. J Am Vet Med Assoc
floxacin for the treatment of feline rhinitis. J Feline Med Surg 2008; 10: 2003; 223: 12831292.
472479. 57 Hendrick MJ and Brooks JJ. Postvaccinal sarcomas in the cat: histology
35 Fischer SM, Quest CM, Dubovi EJ, Davis RD, Tucker SJ, Friary JA, et al. and immunohistochemistry. Vet Pathol 1994; 31: 126129.
Response of feral cats to vaccination at the time of neutering. J Am Vet 58 Wilcock B, Wilcock A and Bottoms K. Feline postvaccinal sarcoma:
Med Assoc 2007; 230: 5258. 20 years later. Can Vet J 2012; 53: 430434.
36 Rochlitz I. Recommendations for the housing of cats in the home, in 59 Srivastav A, Kass PH, McGill LD, Farver TB and Kent MS. Comparative
catteries and animal shelters, in laboratories and in veterinary surger- vaccine-specific and other injectable-specific risks of injection-site
ies. J Feline Med Surg 1999; 1: 181191. sarcomas in cats. J Am Vet Med Assoc 2012; 241: 595602.
37 Lalonde J, Heron W, Gourkow N, Joosting N, Litman M, Bolinder A, et al. 60 Martano M, Morello E and Buracco P. Feline injection-site sarcoma: past,
A code of practice for Canadian cattery operations. Canadian Veterinary present and future perspectives. Vet J 2011; 188: 136141.
Medical Association, 2009. 61 Day MJ, Schoon HA, Magnol JP, Saik J, Devauchelle P, Truyen U, et al.
38 Povey RC and Wilson MR. A comparison of inactivated feline viral A kinetic study of histopathological changes in the subcutis of
rhinotracheitis and feline caliciviral disease vaccines with live-modi- cats injected with non-adjuvanted and adjuvanted multi-component
fied viral vaccines. Feline Pract 1978; 8: 3542. vaccines. Vaccine 2007; 25: 40734084.
39 Iglauer F, Gartner K and Morstedt R. Maternal immunization against 62 Day MJ, Horzinek MC and Schultz RD. Guidelines for the vaccination
feline viral rhinopneumonitis with a booster dose during pregnancy a of dogs and cats. Compiled by the Vaccination Guidelines Group
retrospective clinical study. Kleintierpraxis 1989; 34: 243249. (VGG) of the World Small Animal Veterinary Association (WSAVA).
40 Tizard I and Ni Y. Use of serologic testing to assess immune status of J Small Anim Pract 2007; 48: 528541.
companion animals. J Am Vet Med Assoc 1998; 213: 5460. 63 Morrison WB, Starr RM and the Vaccine-Associated Feline Sarcoma Task
41 Schultz RD, Ford RB, Olson J and Scott F. Titer testing and vaccination: Force. Vaccine-associated feline sarcomas. J Am Vet Med Assoc 2001; 218:
a new look at traditional practices. Vet Med 2002; 97: 113. 697702.
42 Day MJ. Vaccine side effects: fact and fiction. Vet Microbiol 2006; 117: 5158. 64 Woodward KN. Origins of injection-site sarcomas in cats: the possible
43 Moore GE and Hogenesch H. Adverse vaccinal events in dogs and cats. role of chronic inflammation a review. ISRN Vet Sci 2011; 2011.
Vet Clin North Am Small Anim Pract 2010; 40: 393407. Article ID 210982. DOI: 10.5402/2011/210982.
44 Gaskell R, Gettinby G, Graham S and Skilton D. Veterinary Products 65 McEntee M and Page R. Feline vaccine-associated sarcomas.
Committee working group report on feline and canine vaccination. J Vet Intern Med 2001; 15: 176182.
Vet Rec 2002; 150: 126134. 66 Day MJ, Horzinek MC and Schultz RD. WSAVA guidelines for the
45 Gobar G and Kass P. World Wide Web-based survey of vaccination vaccination of dogs and cats. J Small Anim Pract 2010; 51: 338356.
practices, postvaccinal reactions, and vaccine site-associated sarcomas 67 Kirpensteijn J. Feline injection site-associated sarcoma: is it a reason to
in cats. J Am Vet Med Assoc 2002; 220: 14771482. critically evaluate our vaccination policies? Vet Microbiol 2006; 117: 5965.
46 Clark N, Kushner NN, Barrett CB, Kensil CR, Salsbury D and Cotter S. 68 Spickler A and Roth J. Adjuvants in veterinary vaccines: modes of
Efficacy and safety field trials of a recombinant DNA vaccine against action and adverse effects. J Vet Intern Med 2003; 17: 273281.
feline leukemia virus infection. J Am Vet Med Assoc 1991; 199: 14331443. 69 Davis KM, Hardie EM, Lascelles BD and Hansen B. Feline fibrosarcoma:
47 Hines DL, Cutting JA, Dietrich DL and Walsh JA. Evaluation of efficacy perioperative management. Compend Contin Educ Vet 2007; 29: 712714,
and safety of an inactivated virus vaccine against feline leukemia virus 716720, 722729.
infection. J Am Vet Med Assoc 1991; 199: 14281430. 70 Davis KM, Hardie EM, Martin FR, Zhu J and Brownie C. Correlation
48 Starr RM. Reaction rate in cats vaccinated with a new controlled-titer between perioperative factors and successful outcome in fibrosarcoma
feline panleukopeniarhinotracheitiscalicivirusChlamydia psittaci resection in cats. Vet Rec 2007; 161: 199200.
vaccine. Cornell Vet 1993; 83: 311323. 71 Martano M, Morello E, Ughetto M, Iussich S, Petterino C, Cascio P, et al.
49 Davis-Wurzler GM. Current vaccination strategies in puppies and Surgery alone versus surgery and doxorubicin for the treatment of
kittens. Vet Clin North Am Small Anim Pract 2006; 36: 607640, vii. feline injection-site sarcomas: a report on 69 cases. Vet J 2005; 170: 8490.
50 Bennett D, Gaskell RM, Mills A, Knowles J, Carter S and McArdle F. 72 Bergman P. Recent advances in the treatment of feline vaccine-associat-
Detection of feline calicivirus antigens in the joints of infected cats. ed sarcomas. Adv Small Anim Med Surg 2000; 13: 12.
Vet Rec 1989; 124: 329332. 73 Cohen M, Wright J, Brawner W, Smith AN, Henderson R and Behrend EN.
51 Dawson S, Bennett D, Carter SD, Bennett M, Meanger J, Turner PC, et al. Use of surgery and electron beam irradiation, with or without
Acute arthritis of cats associated with feline calicivirus infection. chemotherapy, for treatment of vaccine-associated sarcomas in cats:
Res Vet Sci 1994; 56: 133143. 78 cases (19962000). J Am Vet Med Assoc 2001; 219: 15821589.
52 Kass PH, Barnes WG Jr, Spangler WL, Chomel BB and Culbertson MR. 74 Hershey A, Sorenmo K, Hendrick M, Shofer FS and Vail DM. Prognosis for
Epidemiologic evidence for a causal relation between vaccination and presumed feline vaccine-associated sarcoma after excision: 61 cases
fibrosarcoma tumorigenesis in cats. J Am Vet Med Assoc 1993; 203: 396405. (19861996). J Am Vet Med Assoc 2000; 216: 5861.
53 Hendrick M. Historical review and current knowledge of risk factors 75 Phelps HA, Kuntz CA, Milner RJ, Powers BE and Bacon NJ. Radical exci-
involved in feline vaccine-associated sarcomas. J Am Vet Med Assoc sion with five-centimeter margins for treatment of feline injection-site
1998; 213: 14221423. sarcomas: 91 cases (19982002). J Am Vet Med Assoc 2011; 239: 97106.
54 Lester S, Clemett T and Burt A. Vaccine site-associated sarcomas in cats: 76 Shaw SC, Kent MS, Gordon IK, Collins CJ, Greasby TA, Beckett LA, et al.
clinical experience and a laboratory review (19821993). J Am Anim Hosp Temporal changes in characteristics of injection-site sarcomas in cats:
Assoc 1996; 32: 9195. 392 cases (19902006). J Am Vet Med Assoc 2009; 234: 376380.

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Appendix 1: Frequently asked questions

General FAQs
What is the optimal interval between vaccines? does not need to be delayed if the patient is eating
The minimum vaccination interval during the primary and is not febrile. Should the illness be severe
series is 2 weeks, and the maximum recommended enough to result in fever or significant inappetence,
interval is 4 weeks. Kittens presented 6 weeks or vaccination should be delayed until these clinical
longer following administration of the previous dose of signs have resolved. If the interval between
vaccine should receive at least two doses of vaccine, vaccinations is delayed to greater than 6 weeks in primary
34 weeks apart. Although feline-specific data do not exist, immunizations, the series should be re-initiated. (See
extrapolation from mice and humans suggests that a 3-week Shelter/TrapNeuterReturn FAQs, pages 803804, for
interval is optimal for induction of memory T cells after alternate recommendations for those settings.)
administration of a modified-live virus.1,2
Does it matter if the brand of vaccine used for
When should kittens be vaccinated? revaccination is different from the brand administered
The primary vaccination series in kittens is scheduled previously?
between 6 and 16 weeks of age; vaccines should be While there are no studies comparing all vaccines for a
administered at an interval of 34 weeks. Under high-risk particular antigen (or group of antigens), based on the
circumstances (eg, in shelters and catteries with endemic available information the Advisory Panel believes that,
upper respiratory tract disease or panleukopenia risk), subsequent to the initial series, booster vaccinations do not
vaccination may begin as early as 46 weeks of age and have to be of the same brand or vaccine type.
be repeated every 23 weeks until 16 weeks of age.
Can a parenteral FPV, FHV-1, FCV vaccine that is
How often should senior/geriatric cats be vaccinated? meant to be administered via the subcutaneous route
How should I vaccinate cats with stable chronic disease? be administered intranasally?
Whether older cats respond to vaccination in the same manner No, nor should it be administered by any other mucosal route.
as younger animals do is inadequately studied.3 In the absence It will not stimulate an appropriate immune response and may
of data, the Advisory Panel recommends that healthy older cause clinical disease.
cats and those with chronic but stable disease conditions
receive vaccines in the same manner as younger adults. What is the cause of lameness occasionally seen
Less frequent vaccination is not advised due to inherent after FCV vaccination?
immunosenescence. Further, more frequent immunization In most cases, the lameness and pyrexia are due to
is not warranted in aged patients with a lifelong history of coincidental infection with field feline caliciviruses, though
immunization as data from other species suggests the memory a small proportion may be due to vaccine virus itself.8,9
response remains intact throughout life and protective There is also some evidence of immune complex formation
immunity can be effectively maintained between boosts.46 in the joints of cats infected with some strains of feline
calicivirus,10,11 but this is likely to be an uncommon cause
Should cats be vaccinated against rabies in areas of lameness after vaccination.
where it is not required by law?
With the exception of Hawaii, cats in all of the states of How useful are the dermatophyte vaccines available
the United States and cats in all countries or counties with in some European countries?
endemic rabies of any species should be vaccinated against Dermatophyte vaccines have been marketed for years, but
rabies, even if not required in that jurisdiction. scientific studies to prove their efficacy have been unsatisfactory.
Although some fungal vaccines may improve clinical signs
Should I vaccinate immunocompromised cats? compared with placebo, there does not seem to be a difference
Patients with impaired immune responses, either due to infection in infection rate between vaccinated and unvaccinated cats,
with FIV/FeLV or the use of immunosuppressive therapies, are at and reliable protection has not been documented.12,13
increased risk of infection and may be candidates for vaccination.
Although there is limited feline-specific data, inactivated vaccines Is it safe to mix and administer vaccine from one
are generally regarded as safer in patients with underlying manufacturer with vaccine from another manufacturer?
immunosuppression.7 Because immune responses are hampered No. Only vaccines from the same manufacturer, and only
in immunocompromised patients, vaccination should ideally be when stipulated on the product label/data sheet, may be
updated before immunosuppressive therapies are started. mixed in the same syringe and administered simultaneously.
Retrovirus-infected cats should not be vaccinated against the Mixing vaccines from different manufacturers in the same
retrovirus they are infected with. syringe at the same time carries significant risk that one
product (due to such factors as pH, osmolality, etc) may
Should I vaccinate a kitten or cat with mild illness such rapidly and completely inactivate the immunogenic antigen
as chronic upper respiratory tract infection or diarrhea? in the other product, or even in both products.
In kittens and cats with mild illness, vaccination For this reason, it is recommended that when administering

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vaccine from two different manufacturers to the same patient preferable to vaccines that do not contain added adjuvants?
at the same appointment, separate inoculation sites should There are a number of factors that may play a role in the
be selected (eg, left side vs right side). causation of FISS. Although initial reports linked development
of sarcomas at vaccination sites with the use of inactivated
How long is a vaccine stable for after being vaccines and aluminum-based adjuvants, recent studies
reconstituted? show that all vaccines carry some risk of inducing FISS,
Vaccines should always be stored and handled according as do at least some other injectable products.
to the manufacturers instructions. After reconstitution, Although current information does not clearly show
a vaccine should ideally be used immediately, but certainly differences in risk of FISS development between modified-live
within 1 hour. and inactivated vaccines, some Advisory Panel members feel
that risk might be mitigated by the use of modified-live
Should the skin be disinfected before administering vaccines. However, overall the Advisory Panel concluded
a vaccine? that, at the current time, there is insufficient information to
No, the disinfectant could potentially inactivate modified-live make definitive recommendations to use particular vaccine
vaccine antigens. Cleaning and reusing of syringes is types to reduce the risk of FISS.
discouraged for this reason, as well as the risk of There are indications for using an inactivated vaccine. The
contamination. risks and benefits should be discussed fully with the client.
Some examples of situations where this might be considered
Under what circumstances might an adjuvanted vaccine be are given in Table 6 of the Guidelines (page 797).

Shelter FAQS
Are there special considerations for vaccinating Are there any special vaccine considerations
and housing very young kittens in shelters? for cats living long term (months or years)
It is preferable that kittens younger than 8 weeks in shelters or sanctuaries?
of age be kept in foster care in clean homes. Cats entering a long-term care facility (or any cat for
Interference from MDA and lack of immune which a long-term shelter stay is anticipated) should
competence has a negative impact on the ability of vaccines be vaccinated against rabies at the time of admission, unless
to induce a protective immune response, and kittens placed in a rabies-free region. FeLV vaccination is recommended for
in shelters are at high risk of disease. If kittens younger cats that will be group housed, with the two vaccine primary
than 8 weeks of age must be kept in shelters, they should series ideally completed prior to placement in group housing.
be kept in areas isolated from the general population. Other non-core vaccines (ie, other than FPV, FHV-1, FCV)
When challenge dose is high and exposure is unavoidable, should be considered as for household pet cats (see Table 2,
FHV-1 and FCV intranasal or injectable vaccines may be page 790), depending on risk profile. In the event that a cat
administered to kittens younger than 46 weeks of age. resides in the facility for a sufficiently long period to justify
Some facilities administer one or two drops of intranasal booster vaccination, it is recommended that the same
vaccine rather than the entire dose to each kitten. schedule for revaccination be followed as is recommended
However, unless specifically stated on the label, for pet cats. There is no indication for more frequent
manufacturers have not evaluated the safety and vaccination in a long-term shelter facility with a stable
efficacy of these vaccines when used in this manner, population. Cats in long-term care facilities are at increased
nor have such practices been independently evaluated. risk of calicivirus infections. Use of dual- or multi-strain
As such, use of a partial dose is not recommended. As in calicivirus vaccines in such facilities may be indicated.
older cats, signs of upper respiratory disease may be caused If FCV disease occurs in fully vaccinated cats, changing to
by the vaccine. Nonetheless, in environments with endemic a product with different vaccine strain(s) may be beneficial.
upper respiratory disease where the risk of serious disease
is high, the benefits of vaccinating in this manner may Are vaccine recommendations different for shelter cats
outweigh the risks. that are ill or injured?
Injectable or intranasal modified-live FPV vaccine may The great majority of shelter kittens and cats should be
cause cerebellar hypoplasia if administered to kittens prior vaccinated regardless of physical condition. If the cats
to 4 weeks of age.14 Kittens in high-risk shelters should, immune system is so weakened that a modified-live vaccine
therefore, be vaccinated with a modified-live, injectable FPV will induce disease, exposure to the wide variety of infectious
vaccine no earlier than 46 weeks of age. Vaccination should pathogens present in most shelters will very likely be fatal.
be repeated every 23 weeks until 1620 weeks of age. In general, if a cat cannot be safely vaccinated, it cannot
The shorter end of the inter-vaccination interval and earlier safely remain in an animal shelter except in strict isolation.
age of first vaccination is appropriate when risk of infectious Cats that were injured or ill at the time of initial vaccination
disease is high, such as during an outbreak or in a known should be revaccinated when healthy (no sooner than
contaminated environment. 2 weeks after recovery).

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Should pregnant queens in shelters be vaccinated? respiratory viruses (FHV-1 and FCV). While protection
In general, vaccines are not licensed for use in pregnant generally persists for 3 years,17 the degree of protection
queens unless specifically stated on the product label. may wane over time. It may be helpful to revaccinate cats
The use of modified-live vaccines in naive queens (ie, those for FHV-1 and FCV if they have not received a vaccine in the
that have never been naturally exposed or vaccinated) during previous year. If there is any question about the vaccine
pregnancy is particularly not recommended due to potential history, re-administering vaccines is preferable to reliance
adverse effects of FPV on developing fetuses.15 Nonetheless, on uncertain records.
the likelihood of exposure to FPV is very high in many shelters,
and infection may result in the death of the mother as well as Should cats be vaccinated even if most of them are
her offspring. Therefore, the risks posed by modified-live likely to be euthanased a few days after intake?
vaccination must be weighed against the risks of not Yes, the primary reason to vaccinate cats in high-euthanasia
vaccinating (ie, maternal, fetal or neonatal infection and death). shelters is to prevent the development of endemic FPV
When pregnant queens are being placed into shelters where transmission. Protection against FPV develops in a high
FPV exposure is likely, the Advisory Panel believes that the proportion of cats within the first few days of vaccination
overall benefits of modified-live FPV vaccination outweigh the (if there is no MDA interference). Vaccinating all cats at intake
risks and are preferable in the shelter environment due to the is associated with a decreased risk of widespread FPV
more rapid onset of protection. (See also Tables 3 and 6, on outbreaks.
pages 792 and 797, respectively.)
Vaccination against FHV-1 and FCV during pregnancy may Should cats be vaccinated on intake even if they are
actually be beneficial for both mother and offspring, although stray and, therefore, not the property of the shelter?
vaccines are not actually licensed for such use. Vaccines Yes, stray cats should be vaccinated on intake. Many
administered early in pregnancy will not only protect the community cats have no antibodies to protect against serious
mother, but may provide the offspring with higher levels of illness;18,19 thus, the benefit of vaccination for population
MDA to protect them during the first few weeks of life. and individual health generally greatly outweighs the risk of
Reduced morbidity and mortality from feline upper respiratory vaccination. To decrease risks associated with vaccination,
infection was seen in kittens born to queens vaccinated with antigens and vaccines should be limited to those that present
an inactivated vaccine against FHV-1 and FCV during early a threat in a given shelter environment, and the clinical signs
pregnancy, compared with offspring of queens not vaccinated and procedure for responding to an adverse vaccine reaction
during pregnancy. There was no increase in abortions or should be prominently posted in all areas where vaccines are
stillbirths associated with this practice.16 administered.

Should previously vaccinated cats receive booster Does performing spay/neuter surgery at the time
vaccines at the time of shelter intake? of vaccination diminish immune responses?
In theory there is no reason to administer vaccines at the Kittens sterilized a week before, a week after, or at the time
time of shelter admission if clear documentation of previous of vaccination had similar antibody titers to kittens that were
vaccination within the timeframe recommended by these vaccinated without surgery.20 Anesthesia and surgery do not
Guidelines can be provided. An exception may be for the appear to impede serological responses to vaccination.

Trapneuterreturn FAQs
Does the susceptibility of feral cats to live vaccines were used.18 In contrast, only
common infectious diseases justify investment in inactivated vaccines resulted in a high rate of
vaccination during trapneuterreturn programs? protective antibodies against FHV-1. Nearly all cats
The majority of feral cats admitted to one TNR developed high antibody titers against rabies after a
program lacked protective antibody titers against FPV, FHV-1 single dose of inactivated rabies vaccine.
and rabies.18 The fact that some cats were seropositive
suggests that this population of cats was exposed to infectious How long does a single rabies vaccine protect feral cats
diseases and would benefit from immunization. against infection?
Although there are no reports of long-term evaluation in feral
Are feral cats that receive only a single vaccination cats, vaccine licensing studies have demonstrated 34 year
during the stressful experience of trapping and neutering DOI following a single vaccine administered to laboratory
effectively immunized? kittens. This suggests that while the first rabies vaccine may
The vast majority of feral cats vaccinated at the time of only be recognized by regulatory agencies as valid for a
surgery developed protective antibody titers against FPV-1 single year, it is likely that vaccinated cats are protected for
and FCV by the time they were re-trapped for testing 23 much longer. It is recommended that TNR programs offer
months later, regardless of whether inactivated or modified- vaccine booster services for community cats.

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Adverse event FAQs


What constitutes a vaccine adverse event and Am I legally required to report vaccine adverse
what should I advise clients to watch for? events?
Vaccines are biological products that stimulate a There is no legal mandate to report post-vaccinal
series of complex immune reactions that may reactions in the USA, Canada or the European Union.
manifest transient side effects for up to 2 or 3 days
following vaccination. It is rare that these self-limiting side Am I legally liable for using a protocol based
effects escalate into serious adverse events. It is advisable to on my patients risk that differs from the one on the
inform clients that their cat may experience reduced appetite vaccine insert?
or loss of appetite (lasting for two meals), pain at the injection Continuous medical decision-making is an inherent aspect
site, lethargy, reluctance to play/walk/run, or mild fever. of veterinary medicine. There is no reason to believe that
Treatment is seldom required. decisions regarding vaccine selection and use will carry any
Clients should contact the veterinary practice should any greater legal risk than the myriad other medical decisions
physical or behavioral effects worsen or continue beyond made in daily practice. Relative risk for utilizing these
23 days. In the rare event that signs of systemic illness Guidelines in developing patient vaccination protocols is
(such as vomiting, diarrhea, seizures, facial swelling, collapse considered low. Some of the recommendations included
or difficulty breathing) develop, the owner should contact the in the 2013 AAFP Feline Vaccination Advisory Panel Report
veterinary practice immediately. will differ from the manufacturer recommendations published
in the product package insert/label. However, in most
How do I report a vaccine adverse event? countries, veterinarians in small animal practice have
The Advisory Panel strongly encourages veterinarians considerable discretion in exercising their judgment
to report all known or suspected vaccine adverse events relative to the selection and use of licensed veterinary
to the manufacturer and the appropriate regulatory agency biological products within their professional practice.
responsible for monitoring post-vaccinal adverse events Rabies vaccination is the obvious exception veterinarians
(see details below). are required to follow local laws. (Continued on page 806)

Vaccine manufacturer
Known or suspected adverse events should first be reported to the technical services staff of the vaccine manufacturer.
If multiple vaccines from different manufacturers were administered at the same time, reports should be submitted to
each manufacturer.
Although vaccine manufacturers are required to maintain adverse event reports, they are not required to disclose that
information. They are under no obligation to offer compensation for diagnosis or treatment for alleged injury associated
with vaccine administration.

Licensing/regulatory agencies
United States Veterinarians practicing within the United States may contact the United States Department of
Agriculture (USDA), Animal and Plant Health Inspection Service (APHIS), Center for Veterinary Biologics (CVB):
Web: http://www.aphis.usda.gov/animal_health/vet_biologics/vb_adverse_event.shtml
Fax or mail: Download the PDF form at http://www.aphis.usda.gov/animal_health/vet_biologics/publications/
adverseeventreportform.pdf and FAX to (515) 337-6120 or MAIL to the CVB, 1920 Dayton Avenue, PO Box 844, Ames,
Iowa 50010, USA
Telephone: (800) 752-6255
Canada The Canadian Food Inspection Agency (CFIA) is responsible for licensing veterinary biologics,
including veterinary vaccines that are manufactured and/or used in Canada. The licensing program operates under
the Health of Animals Act and Regulations, and is administered by the Canadian Centre for Veterinary Biologics.
Form CFIA/ACIA 2205 Notification of Suspected Adverse Events to Veterinary Biologics may be found at:
http://inspection.gc.ca/english/for/pdf/c2205e.pdf
European Union Oversight lies with the European Medicines Agency (EMA) and the national veterinary medicines
agencies. For example, in the United Kingdom, the Veterinary Medicines Directorate (VMD), an agency of the Department
for Environment, Food and Rural Affairs, is responsible for the Suspected Adverse Reaction Surveillance Scheme
(SARSS) for veterinary medicines.
Adverse reactions in animals in the UK should be reported at:
http://www.vmd.defra.gov.uk/adversereactionreporting/default.aspx
Suspected human reactions to veterinary medicines in the UK should be reported at:
http://www.vmd.defra.gov.uk/adversereactionreporting/default.aspx
Or contact the VMD at Freepost KT4503, Woodham Lane, New Haw, Addlestone, Surrey, KT15 3BR, UK.
Telephone: 01932 338427 Fax: 01932 336618

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Veterinarians may be held liable for injury or death caused considerations), Certificate of Exemption from Rabies
by administration of a vaccine or any other medication. Vaccination, or vaccination documentation, please refer
Effective client communication is the best way to avoid to the 2006 Guidelines (see box on page 786).
legal consequences. Communication of risk and benefit
information to clients should be in direct and simple terms. What do I do if a patient has had a previous
With respect to documentation, practitioners should vaccine adverse event?
determine what best suits their practice and their level of risk Refer to page 796 for recommendations regarding the
tolerance. For more information on informed consent (legal approach to anaphylaxis and allergic reactions.

References for the FAQs (Appendix 1)


1 Wherry EJ, Teichgraber V, Becker TC, Masopust Carter S and McArdle F. Detection of feline
D, Kaech SM, Antia R, et al. Lineage relation- calicivirus antigens in the joints of infected
ship and protective immunity of memory cats. Vet Rec 1989; 124: 329332.
CD8 T cell subsets. Nat Immunol 2003; 4: 12 Westhoff D, Orveillon FX, Farnow D, Kls M-C
225234. and Elbers K. Safety of a non-adjuvanted
2 Wherry EJ and Ahmed R. Memory CD8 T-cell therapeutic vaccine for the treatment of feline
differentiation during viral infection. J Virol dermatophytosis. Vet Rec 2010; 167: 899903.
2004; 78: 55355545. 13 Westhoff DK, Kloes M-C, Orveillon FX, Farnow D,
3 Day MJ. Ageing, immunosenescence and Elbers K and Mueller RS. Treatment of feline
inflammageing in the dog and cat. J Comp dermatophytosis with an inactivated fungal
Pathol 2010; 142: S60S69. vaccine. Open Mycol J 2010; 4: 1017.
4 Mouzin D, Lorenzen M, Haworth J and King V. 14 Sharp NJ, Davis BJ, Guy JS, Cullen JM,
Duration of serologic response to three viral Steingold SF and Kornegay JN. Hydran-
antigens in cats. J Am Vet Med Assoc 2004; encephaly and cerebellar hypoplasia in
224: 6166. two kittens attributed to intrauterine parvo-
5 Ottiger HP, Neimeier-Forster M, Stark KD, virus infection. J Comp Pathol 1999; 121:
Duchow K and Bruckner L. Serological 3953.
responses of adult dogs to revaccination 15 Greene C and Addie D. Feline parvovirus infec-
against distemper, parvovirus and rabies. tions. In: Greene C (ed). Infectious diseases of
Vet Rec 2006; 159: 712. the dog and cat. 3rd ed. St Louis: Elsevier
6 Scott F and Geissinger C. Long-term immunity Saunders, 2006, pp 7888.
in cats vaccinated with an inactivated tri- 16 Iglauer F, Gartner K and Morstedt R. Maternal
valent vaccine. Am J Vet Res 1999; 60: 652658. immunization against feline viral rhino-
7 Buonavoglia C, Marsilio F, Tempesta M, pneumonitis with a booster dose during
Buonavoglia D, Tiscar PG, Cavalli A, et al. Use pregnancy a retrospective clinical study.
of a feline panleukopenia modified live virus Kleintierpraxis 1989; 34: 243249.
vaccine in cats in the primary-stage of feline 17 Scott F and Geissinger C. Duration of immuni-
immunodeficiency virus infection. Zentralbl ty in cats vaccinated with an inactivated feline
Veterinarmed B 1993; 40: 343346. panleukopenia, herpesvirus, and calicivirus
8 Radford AD, Dawson S, Wharmby C, Ryvar R vaccine. Feline Pract 1997; 25: 1219.
and Gaskell RM. Comparison of serological 18 Fischer SM, Quest CM, Dubovi EJ, Davis RD,
and sequence-based methods for typing Tucker SJ, Friary JA, et al. Response of feral
feline calcivirus isolates from vaccine failures. cats to vaccination at the time of neutering.
Vet Rec 2000; 146: 117123. J Am Vet Med Assoc 2007; 230: 5258.
9 Radford AD, Bennett M, McArdle F, Dawson S, 19 DiGangi BA, Gray LK, Levy JK, Dubovi EJ and
Turner PC, Glenn MA, et al. The use of Tucker SJ. Detection of protective antibody
sequence analysis of a feline calicivirus (FCV) titers against feline panleukopenia virus,
hypervariable region in the epidemiological feline herpesvirus-1, and feline calicivirus in
investigation of FCV related disease and shelter cats using a point-of-care ELISA.
vaccine failures. Vaccine 1997; 15: 14511458. J Feline Med Surg 2011; 13: 912918.
10 Dawson S, Bennett D, Carter SD, Bennett M, 20 Reese MJ, Patterson EV, Tucker SJ, Dubovi EJ,
Meanger J, Turner PC, et al. Acute arthritis of Davis RD, Crawford PC, et al. Effects of anes-
cats associated with feline calicivirus infec- thesia and surgery on serologic responses to
tion. Res Vet Sci 1994; 56: 133143. vaccination in kittens. J Am Vet Med Assoc
11 Bennett D, Gaskell RM, Mills A, Knowles J, 2008; 233: 116121.

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Appendix 2: Pet Owner Guide

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S P E C I A L A R T I C L E / 2013 AAFP feline vaccination guidelines

The Pet Owner Guide may be downloaded from www.catvets.com/guidelines/client-brochures and is also available as a Supplementary File
(see page 799)

808 JFMS CLINICAL PRACTICE Available online at jfms.com and catvets.com


Reprints and permission: sagepub.co.uk/journalsPermissions.nav