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Abstract

Rationale:

This Report was developed by the Feline Vaccination Advisory Panel of the American Association of Feline Practitioners (AAFP) to provide practical recommendations to help clinicians select appropriate vaccination schedules for their feline patients based on risk assessment. The recommendations rely on published data as much as possible, as well as consensus of a multidisciplinary panel of experts in immunology, infectious disease, internal medicine and clinical practice.

Introduction

The AAFP produced the first organization-driven vaccination guidelines in 1998. These were updated in 2000 and again in 2006.¹ Each version has offered a comprehensive review of the literature and has provided recommendations for vaccine protocols based on known science along with some extrapolation between studies and between species when feline studies were not available. This Report has used the same criteria.

The practicing veterinarian is in the best position to determine how to put these Guidelines into practice for an individual patient. The veterinarian should undertake a clinical risk/benefit assessment for each animal and discuss recommended vaccination schedules with the owner so that they can make an informed choice. The assessment should include discussion on the likelihood of exposure, the health and lifestyle of the animal, and the risks related to vaccination.

The Advisory Panel recognizes that situations differ in different countries, and that every country will have slightly different issues and priorities; thus these Guidelines will not necessarily be applicable to every country and the practitioner must interpret accordingly.

The three international panels that have produced feline vaccination guidelines (AAFP, World Small Animal Veterinary Association and European Advisory Board on Cat Diseases) recommend that an annual health examination be performed irrespective of whether vaccines are administered. While the optimal frequency of health examinations for cats is unknown, it is generally accepted that healthy adult cats should be examined at least once a year. In the past, annual veterinary visits were structured around vaccinations as the primary focus. With the increasing body of knowledge about duration of immunity (DOI) from vaccinations, their potential adverse effects, and the increased awareness of pet owners about these issues, it is clear that vaccination no longer justifies the need for annual visits.

Practitioners are encouraged to help cat owners understand the value of regular health care and that it ideally should be proactive rather than reactive. A useful approach is for health care to be tailored to the various feline life stages, which improves early recognition of potential health-related issues and can facilitate treatment.²

A Pet Owner Guide, discussing the risks and benefits of vaccination, is included as Appendix 2 (pages 807 and 808).

Vaccination principles

Vaccination plays an important role in the control of infectious diseases, both for an individual as well as for the cat population (ie, herd health). Some vaccine antigens are also used to lessen the potential for zoonotic spread of disease (eg, rabies). The benefits of routine and widespread vaccination are clear: the incidence of serious disease caused by highly pathogenic organisms, such as feline parvovirus (panleukopenia), can be reduced in populations in which widespread vaccination is practised. However, the level of protection conferred by a particular vaccine in an individual patient varies. The quality of vaccine-induced immunity in any patient is influenced by a complex interaction of factors unique to the individual patient, the patient’s environment, and the nature of the vaccine and pathogen. Precisely predicting either the outcome of vaccination or subsequent exposure to a pathogen is difficult (or impossible) and, therefore, vaccination should never be offered as a guarantee of protection.

The risk of infection and subsequent development of disease varies with a number of factors including the age and health of the cat, magnitude of exposure to the infectious agent, the pathogenicity of individual agents, the geographic prevalence of infection and the vaccination history of the cat. Some of the factors that negatively affect an individual animal’s ability to respond to vaccination include interference from maternally derived antibodies (MDA), congenital or acquired immuno- deficiency, concurrent disease or infection, inadequate nutrition, immunosuppressive medications, chronic stress and an aging immune response. Additionally, some vaccinal agents (eg, FPV) will induce a much stronger protective immune response than others (eg, feline herpesvirus [FHV-1]). As vaccine-afforded protection against both infection and disease is thus variable and not absolute, exposure to infected animals and infectious agents should be minimized, even after vaccination.

Kittens are generally more susceptible to infections than adult cats are and typically develop more severe disease (Figure 1). Thus, they represent a principal primary target population for vaccination. As part of a routine health care program, the vaccination needs of all cats, including adults, should be assessed at least once a year, in conjunction with a comprehensive physical examination and consultation, modifying vaccination recommendations as necessary on the basis of altered risk/benefit ratio.

Figure 1

Kittens are more susceptible to infection than adult cats are, and are a principal primary target population for vaccination. Courtesy of Dr Deb Givin

Vaccination is a medical procedure, and the decision to vaccinate, even with core vaccines (see box above), should be based on a risk/benefit assessment for each cat and for each vaccine antigen. Vaccination may indeed be beneficial, but it is not innocuous, and the benefit of vaccinating an animal (eg, the induction of clinically meaningful immunity) must be balanced against the risk of adverse events, likelihood of exposure and severity of disease. Where practical, every effort should be made to ensure that cats are healthy prior to vaccination; however, concurrent illness should not necessarily preclude vaccination.

The overall objectives of vaccination are shown on the right.

General information on types of feline vaccines

Vaccines, including different products licensed to protect against the same pathogen, are not necessarily alike. Different vaccine technologies may directly influence efficacy, safety, DOI and route of administration of individual products. Awareness of fundamental differences is necessary.

The following terminology is used throughout these Guidelines to describe types of vaccines: inactivated (killed), modified-live (attenuated) and recombinant. The attributes of each vaccine type are summarized in Table 1.

Table 1

Examples of different types of feline vaccines and their attributes

	Inactivated (killed)	Modified-live (attenuated)	Recombinant
Examples	Panleukopenia, herpesvirus-1, calicivirus, FeLV, FIV, Chlamydophila, rabies, dermatophytosis	Panleukopenia, herpesvirus-1, calicivirus, Chlamydophila, Bordetella bronchiseptica	rRabies, rFeLV
Replication following administration	Does not replicate (non-infectious)	May replicate locally and in sites beyond the inoculation site (infectious)	Does not replicate (non-infectious)
Initial vaccination, in the absence of maternal antibody NB It is not practical to determine the persistence of MDA for individual kittens; vaccination until ≥16 weeks of age is advisable	Two initial doses are required, 3–4 weeks apart. Protective immunity is expected within 7–10 days following the second dose. Rabies vaccine is the exception as only one initial dose is required; protective immunity is expected to develop by 28 days	Two initial doses are required, 3–4 weeks apart. Protective immunity is expected within 7–10 days following the second dose	rRabies: One dose is required. Protective immunity is expected to develop by 28 days. rFeLV: Two initial doses are required, 3–4 weeks apart. Protective immunity is expected within 7–10 days following the second dose
Route(s) of administration as stipulated by the manufacturer	Injectable: SC or IM*	Injectable: SC or IM* Mucosal: Intranasal (IN)**	Injectable: SC
Adjuvanted	Yes – the majority	Not required	Some individual products contain an adjuvant
Therapeutic indications	Dermatophytosis (in some European countries)	None	None
Reversion to virulence	Not possible	Theoretically possible, but highly unlikely	Not possible

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

Characteristics of vaccine types have been reviewed as recently as 2011.³ All veterinary vaccines, prior to licensing, are subjected to testing for efficacy, safety, potency and purity. Testing methods may vary among different manufacturers and licensing authorities. While all licensed vaccines need to meet minimum efficacy standards, the level of protection induced can vary depending on many factors, including the method used to manufacture the product. For further information on licensing, readers should refer to the 2006 Guidelines (see box on page 786) and to individual licensing authorities (United States Department of Agriculture [USDA]; Canadian Food Inspection Agency [CFIA]; Veterinary Medicines Directorate [VMD], Department for Environment, Food, and Rural Affairs [DEFRA], UK; European Medicines Agency [EMA], EU).

The principal differences between inactivated, modified-live and recombinant vaccines are discussed below.

Inactivated vaccines Vaccinal pathogens can be completely inactivated (ie, killed) by various means, eliminating risk of replication post-inoculation or ‘reversion to virulence’. For these reasons, inactivated vaccines have historically been regarded as the safest vaccines. However, the inclusion of a variety of extraneous chemicals (stabilizers, preservatives), antibiotics, adjuvants and excipient proteins has been implicated as a cause of both acute and delayed adverse reactions in cats.⁴

Modified-live vaccines For some agents, intact pathogens can be modified so that they retain the ability to replicate in the host and provoke an immune response, but not cause clinical disease. Altered pathogenicity effectively induces subclinical infection and can result in a more rapid onset of immunity for some vaccine antigens than with comparable inactivated vaccines.^5,6 All bacterial and viral vaccines licensed for mucosal (intranasal) administration are modified-live, as are a number of injectable vaccines.

Recombinant vaccines Discrete genetic sequences can be isolated from a pathogenic virus or bacterium that encode immunogenic proteins. These sequences can either be recombined with the DNA of a live, non-pathogenic virus, which can then be administered as a vaccine (vectored vaccine), or they may be inserted in bacterial plasmids to enable in vitro production of antigens that can be harvested and purified for incorporation into a vaccine (ie, subunit vaccine). Examples of both types of vaccines are licensed for use in veterinary medicine.

Risk/benefit assessment

In assessing the risk for an individual cat, information about the cat, the environment and infectious agents to which the cat will be realistically exposed needs to be considered. Specifically, questions need to be asked that address the cat’s lifestyle as well as the lifestyle of any other cats in the same household. Queries should also be posed regarding other sources of exposure, such as excursions outside the home, boarding and travel.

Patient

Age is an important element in assessing an individual’s risk profile. Most infectious diseases are more prevalent in kittens, and kittens less than 6 months old are generally more susceptible to infection and disease than adult cats are. Kittens, therefore, represent a principal primary target population for vaccination.

MDA provide important protection for the kitten, but may also interfere with, or neutralize, vaccines. As the level of MDA varies among individuals, the age at which a kitten may be able to respond to vaccination will also vary, and in some cases may be 16 weeks or older. While information is available on the variability of MDA as pertains to FHV-1, FCV and FPV, limited data is available for other antigens; thus the role of MDA in interference with vaccination against rabies, FeLV or other pathogens is unknown. Stopping a vaccination course too early (when MDA are still interfering) is thought to be the single most common cause of vaccination failure in kittens.

Patient’s environment

Population density and opportunity for exposure to other cats (eg, whether the cat is free-roaming or has access to the outdoors) are among the most critical issues affecting risk of exposure to an infectious agent. Cats and kittens living in multiple-cat households and environments (eg, boarding, breeding, foster or shelter facilities) are likely to have a substantially higher risk of infection than are cats living indoors in one- or two-cat households. Furthermore, the introduction of new cats into a household poses a potential risk – not only to the cat entering the household, but also to the whole group because of possible exposure to new infectious agents. The immunosuppressive effects of stress inherent in the change of social demographics may also result in recrudescence and an increased susceptibility to infection and disease. Conversely, cats that are naturally exposed to infectious agents after vaccination may have an opportunity for ‘natural boosting of immunity’ that may not be afforded to cats kept alone.

Indoor cats generally have a low risk of exposure to infectious agents, particularly where the agent in question is only transmitted by direct contact among cats. However, they may also be exposed to infection from other cats in the household (ie, subclinically infected or carrier cats), or by indirect transmission of pathogens brought in from outside on owners’ clothing, shoes, etc. In theory, strictly indoor cats may be more susceptible to developing panleukopenia because they do not receive boosting through the possibility of natural exposure. It is important to ask owners about other exposure that indoor cats may have, such as supervised visits out of doors (eg, on harness/leash, in the garden, etc), visiting other cats in an apartment building, balconies or roof gardens, visiting cats that belong to other family members, and staying in boarding facilities. Fostering shelter cats alters the risk for the resident cats, both through potential direct exposure to infectious agents as well as through stress-induced immunosuppression.

Trap–neuter–return (TNR) and other special situations are discussed on pages 791–794.

Geographic distribution of infectious agents may result in substantially different risks of exposure for cats living in different areas (eg, rabies). Questions regarding future travel should be included in determining the risk of exposure to specific infectious agents. Periodic housing in boarding facilities, shelters or breeding facilities or other multiple-cat households also places cats at increased risk of exposure to a variety of infectious agents, although the risk will vary substantially between different situations.

Infectious agent

Independent agent-associated variables, such as virulence, strain variation and mutation, challenge dose and stability in the environment, influence the outcome of infection. These are difficult to assess objectively.

Recommendations for vaccination of household pet cats

Developing universal guidelines for vaccination of household pet cats is complicated by the lack of a clear definition of what is, and what is not, a ‘pet cat’. What follows are reasonable recommendations, based on scientific evidence and expert advice, applicable to most cats presented to private practitioners. Differences in cat population density, introduction of new cats, and exposure risk are dynamic variables that the veterinarian must take into consideration when recommending any vaccine for any cat. It is advised that veterinarians reassess risk factors for exposure to infectious disease at each visit (at least once a year), as changes in factors such as the health of the animal or its lifestyle may dictate changes to vaccination needs.

Table 2 summarizes vaccination recommendations for household pet cats.

Table 2

Recommendations for vaccination of household pet cats

	Initial vaccination
Vaccine	Kittens (<16 weeks old)	Adults (16+ weeks old)	Revaccination (boosters)	Comments
Panleukopenia + herpesvirus-1 + calicivirus (FPV, FHV-1, FCV) Modified-live and inactivated. Recommended for all cats	Administer the first dose as early as 6 weeks of age, then every 3–4 weeks until 16–20 weeks of age^7 –11	Administer two doses, 3–4 weeks apart	Revaccinate 1 year after primary series; thereafter, boost every 3 years, lifelong	Modified-live and inactivated vaccines are available for parenteral administration; in some countries intranasal vaccines are also available. For cats going into boarding or another high exposure, stressful situation, a booster 7–10 days prior to boarding may be warranted, particularly if the cat has not been vaccinated in the preceding year
Feline leukemia (FeLV) Inactivated and recombinant	Administer two doses, 3–4 weeks apart, beginning as early as 8 weeks of age	Administer two doses, 3–4 weeks apart	Administer a single dose 1 year following administration of the initial two-dose series. Results of several studies indicate that FeLV vaccine-induced immunity persists for at least 12 months following vaccination.^12–14 Thereafter, the Advisory Panel recommends revaccination every 2 years for cats at low risk of infection and annually for cats at higher risk. A study by Jirjis et al suggests that DOI induced by some FeLV vaccines may last for at least 2 years.¹⁵ Another guidelines group (European Advisory Board on Cat Diseases) recommends that for cats older than 3–4 years of age, a booster vaccination every 2–3 years is sufficient.¹⁶ (see accompanying Disease Information Fact Sheet on FeLV – details on page 799)	Test first to verify FeLV antigen-negative status. As kittens are more susceptible to progressive FeLV infection,¹⁷ and as the eventual environment into which a kitten will go can rarely be predicted with certainty, the Advisory Panel recommends routine FeLV vaccination for all kittens up to and including 1 year of age.¹⁸ At-risk adult cats should continue to be vaccinated against FeLV
Rabies Inactivated and recombinant. Necessary for all cats where legally mandated or in an endemic region	Administer a single dose at not less than 12 weeks/3 months of age	Administer a single dose	Administer a single dose 1 year following the initial dose; then repeat annually (or every 3 years if using a vaccine licensed for this interval)	Where rabies vaccination is required, the frequency of vaccination may differ from these recommendations based on local statutes or requirements. Veterinarians should be familiar with, and adhere to, local requirements

NB Unless otherwise stipulated, all parenteral vaccines should be administered by the subcutaneous route

Additional considerations when vaccinating household pet cats

Because vaccination requirements and risk of exposure to infectious agents vary among household pet cats, individual vaccination protocols will vary. The following recommendations address some alternative situations and offer insights on vaccination of pet cats using non-core vaccines.

Vaccination of pet cats in indoor/outdoor households Cats housed exclusively indoors generally do not require vaccination beyond the aforementioned vaccines (ie, FPV, FHV-1, FCV ± FeLV, rabies). However, in multiple-cat households where some cats are housed exclusively indoors, yet other cats are permitted outside unmonitored, the entire household may be at risk of exposure to additional agents. Veterinarians should consider recommending vaccination of the entire household for selected diseases (eg, FeLV ± rabies) if exposure risk is deemed significant.

Pet cats that spend most (or all) of their lives outdoors are at greater risk of exposure to most infectious diseases compared with predominantly indoor pet cats (Figure 2). Offsetting this is the natural boosting of immunity they may receive if they are exposed to infectious agents. Among outdoor adult cats, exposure risk for rabies, FeLV and FIV is generally higher than for indoor cats. In addition to the conventional vaccines recommended in Table 2, FIV vaccination could be considered for outdoor cats. (See accompanying Disease Information Fact Sheet on FIV – details on page 799.)

Vaccination of pet cats entering boarding facilities Although, in general, healthy adult cats only require boosters to FPV, FHV-1, FCV vaccines every 3 years, an additional booster 7–10 days prior to boarding may be warranted (and may be required by some catteries), particularly if the cat has not been vaccinated in the previous year. Boarding may be stressful for a cat and also, depending on the cattery and the situation at the time, may lead to exposure to infectious agents. However, disease control measures vary between facilities, with many providing individual housing, sneeze barriers and good hygiene, whereas others permit co-mingling of cats, which will clearly facilitate disease transmission. In the event that kittens must enter a boarding facility, it is recommended that they should have received at least two doses of FPV, FHV-1, FCV vaccine, with the last dose 7–10 days prior to entry. In addition, it is strongly recommended that kittens be isolated from the general population of adult cats at all times while boarding.

Vaccination during pregnancy and lactation Vaccination of pregnant or lactating cats is generally not recommended. Whenever possible, queens should be vaccinated before breeding. Vaccines are not evaluated for use in pregnant queens unless specifically stated on the label. However, the benefits of vaccination may outweigh the risks in endemic disease situations. Modified-live FPV vaccines should not be administered to pregnant queens as this has been associated with cerebellar hypoplasia in the kittens.¹⁹ (For a more comprehensive discussion, see ‘Recommendations for vaccination of cats housed in breeding catteries’, page 793.)

Overdue for vaccination If the cat has been vaccinated previously and is overdue for revaccination (irrespective of the interval), generally a single vaccination is all that is required. If prior vaccination status is unknown, the cat should be treated as unvaccinated.

Bordetella bronchiseptica, Chlamydophila felis, FIP and FIV vaccination For information on the use of these vaccines, see accompanying Disease Information Fact Sheets (details on page 799).

Dermatophytosis vaccination At the time of writing, a monovalent (Microsporum canis) and a multivalent (Microsporum and Trichophyton species) inactivated product are licensed for the prevention and treatment of dermatophytosis in cats in some countries in Europe. None are currently available in the USA or Canada. Limited evidence exists to support the safe use of these products as part of a comprehensive treatment protocol in cats with proven infection, but little evidence is available to support their use for prevention of infection.^20,21

Figure 2

Pet cats that spend any time outdoors are at greater risk of exposure to many infectious diseases compared with indoor-only pet cats. Images courtesy of Dr Terry Curtis (a), Dr Margie Scherk (b) and Karen James (c)

Recommendations for vaccination of shelter-housed cats

Generally, shelter-housed cats (Figure 3) can be considered to be at especially high risk of exposure to infectious disease. Endemic disease, high rates of turnover, stress and sustained exposure are contributing factors. Vaccination in shelters should be limited to those diseases that are likely to be transmitted within the shelter itself. For diseases of concern in shelters (notably FPV and upper respiratory infections), vaccines may be indicated at an earlier age, and be administered at shorter intervals compared with schedules for pet cats. Rapid onset of protection is critical; therefore, administration of FPV, FHV-1, FCV vaccines should be considered for all cats at the time of (or ideally, before) intake.

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

Table 3 summarizes vaccination recommendations for shelter-housed cats.

Table 3

Recommendations for vaccination of shelter-housed cats

Vaccine	First inoculation	Subsequent inoculations		Comments
		Kittens	Adults
Panleukopenia + herpesvirus-1 + calicivirus (FPV, FHV-1, FCV) Modified-live (use of inactivated vaccine is not generally recommended except where panleukopenia risk is low). Recommended for all cats	Administer a single dose at intake or, where possible, at least 1 week prior to shelter entry. In kittens, administer the first dose as early as 4–6 weeks of age	Revaccinate every 2–3 weeks until 16–20 weeks of age^7 –10	Revaccinate once, 2–3 weeks following administration of the initial vaccine	Recent studies show that ML SC vaccination may provide better protection in the face of MDA than inactivated vaccines do, and may protect against illness even when cats are placed in a contaminated environment soon after vaccination.^22,23 ML injectable or IN vaccines containing FPV should not be given to kittens less than 4 weeks of age due to the risk of cerebellar hypoplasia¹⁹ or clinical panleukopenia (see Appendix 1 [Shelter FAQs] ‘Are there special considerations for vaccinating and housing very young kittens in shelters?’, page 803). For pregnant queens, risk of exposure versus risk of vaccination should be balanced (see Appendix 1 [Shelter FAQs] ‘Should pregnant queens in shelters be vaccinated?’, page 804). Inactivated multivalent calicivirus vaccines exist and may provide broader cross-protection against calicivirus infection than single strain vaccines.^24,25 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 herpesvirus-1 + calicivirus (IN FHV-1, FCV) Modified-live If IN* vaccination is used for control of respiratory viruses, all shelter cats over 4–6 weeks of age should simultaneously receive a SC ML FPV vaccine (with or without respiratory viral antigens)	Administer a single dose at intake or, where possible, at least 1 week prior to shelter entry. In kittens, administer the first dose as early as 4–6 weeks of age	Revaccinate every 2–3 weeks until 16–20 weeks of age^8–10	Revaccinate once, 2–3 weeks following administration of the initial vaccine	IN vaccination may result in onset of protection as early as 4–6 days post-inoculation.^6,28 Study results have been mixed* regarding reduction in risk for upper respiratory tract infection in shelters from IN vaccination.^29,30 When using IN vaccination, use only products licensed and approved for administration by this route. Transient, mild signs of upper respiratory infection may develop following administration of vaccine by the IN route
Rabies Inactivated or recombinant	Administer a single dose at the time of entry or release from the facility, depending on risk and length of stay	As for household pet cats (Table 2). NB Rabies vaccine should not be administered to kittens less than12 weeks/3 months old	As for household pet cats (Table 2)	Necessary for all cats where legally mandated or in an endemic region. For shelters adopting out virtually all cats, or where the length of stay is commonly months or longer, rabies vaccine should be administered on intake. For shelters with shorter lengths of stay or where not all cats are adopted, rabies vaccination at the time of release is acceptable. If local regulations prohibit issuance of a rabies certificate for vaccines administered at the shelter, cats should receive a rabies vaccination from a local veterinarian within 4 weeks of adoption
Feline leukemia (FeLV) Inactivated or recombinant	Administer a single dose of vaccine at the time of intake if group-housed. If group (rather than individual) housing for kittens is used, vaccinate as early as 8 weeks of age	Revaccinate with a second dose 2–3 weeks later	Revaccinate once, 3–4 weeks following administration of the initial vaccine	Unlike group-housed cats, risk of FeLV transmission is very low for individually housed cats. FeLV vaccination is recommended for cats in long-term shelters or in group-housing of unrelated cats. Vaccination is not a substitute for testing and segregation of infected cats

NB Unless otherwise stipulated, all parenteral vaccines should be administered by the subcutaneous (SC) route

IN vaccination may provide protection against herpesvirus infection within 4–6 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

Additional considerations when vaccinating shelter-housed cats

Bordetella bronchiseptica and Chlamydophila felis vaccination The benefit of routine vaccination of shelter-housed cats against these disease agents is limited. The association between B bronchiseptica isolation and disease in shelters is inconsistent^31
–34 and C felis is not commonly isolated from shelter cats with upper respiratory infection.³¹ These vaccines should only be considered if the pathogens have been demonstrated as a current problem by laboratory diagnostics. B bronchiseptica vaccination should also be used where there is potential direct or indirect contact between cats and dogs on the same site, and the dogs have a recent or current history of infectious respiratory disease.

FIV and FIP vaccination Vaccination of shelter-housed cats against these agents is not generally recommended.

Dermatophytosis vaccination See comments in the household pet cats section.

Recommendations for vaccination of cats in trap–neuter–return programs

Most community cats (Figure 4, ie, free-roaming unowned feral and stray cats) lack protective 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 2–3 months later, regardless of whether inactivated or modified-live vaccines were used.³⁵ In contrast, only inactivated vaccines resulted in a high rate of protective antibodies against FHV-1.³⁵

Figure 4

Community cats in TNR programs (a,b) should receive FPV, FHV-1, FCV and rabies vaccines at the time of surgery. Images courtesy of International Cat Care

In the same study, nearly all cats developed high antibody titers against rabies after a single dose of inactivated rabies vaccine.³⁵ Vaccine licensing studies have demonstrated 3–4 year DOI following a single vaccine administered to laboratory kittens. This suggests that, while the first rabies vaccine may only be recognized by regulatory agencies as valid for a single year, it is likely that vaccinated cats are protected for much longer.

It is the recommendation of the Advisory Panel that cats in TNR programs receive FPV, FHV-1, FCV and rabies vaccines at the time of surgery.

Recommendations for vaccination of cats housed in breeding catteries

Breeding catteries are variable in size, population and the nature of available facilities. The cat population may number less than 10 individuals or more than 50. Cats of various ages and life stages are typically present and many catteries continue to house retired breeding individuals that have been neutered. Some also contain household pets that may or may not have access to outdoors. The facilities may be sophisticated enough to allow for segregation of subpopulations or all individuals may be housed together. Generally, the medical and vaccination history of the residents is well known, but some diseases, such as upper respiratory tract disease, may be endemic.

Vaccination programs should be limited to those diseases that are relevant to the cattery and should be determined by analysis of risk factors. When assessing the level of disease risk in catteries, factors to consider include:

Rate of population turnover.

Population size and density.

Number of litters/year (Figure 5).

Presence of endemic disease.

Figure 5

The number of litters produced per year in a breeding cattery is one of the key factors in determining the level of disease risk, and devising an appropriate vaccination program. Courtesy of Betsy Gaither

Transmission of infectious diseases is facilitated by group living, young kittens mixing with older kittens and adults, contact during mating, introduction of new cats, and movement of cats into and out of the cattery (eg, queens going to other catteries for breeding, return of previously sold cats, travel for cat shows or other exhibitions). Catteries assessed as low risk would be considered similar to pet homes (Table 2), whereas catteries assessed as high risk would be considered similar to shelters (Table 3), pet stores, etc. In high-risk environments, vaccines may be used at an earlier 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 relevant information (eg, antigen, brand, date, vaccination site, adverse events, etc). Management and husbandry have an important impact on the health of individual cats in catteries. Relevant references and resources should be consulted.^36,37

Table 4 summarizes vaccination recommendations for cats in breeding catteries.

Table 4

Recommendations for vaccination of cats in breeding catteries

Vaccine	Breeding adults	Kittens	Pregnant and lactating queens
Panleukopenia + herpesvirus-1 + calicivirus (FPV, FHV-1, FCV) Recommended for all cats	Low risk As for household pet cats (Table 2) High risk Consider FHV-1 and FCV vaccination every 1–2 years. Consider ML vaccines for rapid onset of protection. Bi- or multivalent FCV vaccines may provide broader cross-protection than single strain vaccines.^24,25 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	Low risk As for household pet cats (Table 2) High risk ML injectable vaccine starting at 4–6 weeks, boosters every 2–3 weeks until 16–20 weeks^7 –11 Endemic upper respiratory tract disease IN vaccination (FHV-1, FCV only) starting at 3–4 weeks for rapid onset of protection,⁶ followed by injectable ML FPV, FHV-1, FCV every 2–3 weeks until 16–20 weeks. The efficacy of administering one or two drops of IN vaccine per kitten instead of a full dose is unknown and is not recommended. Avoid ML IN or injectable vaccines containing FPV in kittens less than 4 weeks of age due to the risk of cerebellar hypoplasia¹⁹ or clinical panleukopenia. Kittens can be vaccinated around or at the time of spay/neuter surgery without compromising serologic response⁸	Whenever possible, queens should be vaccinated before breeding. However, benefits of vaccination may outweigh risks in endemic disease situations. Though not generally licensed for such use, vaccines administered early in pregnancy may protect the queen and provide enough MDA to protect kittens during the first weeks of life.³⁸ No increase in abortions or stillbirths was documented in one study using an inactivated vaccine in this way.³⁹ ML injectable or IN vaccines containing FPV should not be given to kittens less than 4 weeks of age due to the risk of cerebellar hypoplasia¹⁹ or clinical panleukopenia. For pregnant queens, risk of exposure versus risk of vaccination should be balanced. 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

Additional considerations when vaccinating cats in breeding catteries

FeLV and FIV vaccination Vaccination of cats in breeding catteries against these agents is not generally recommended. Vaccinate if necessary by analyzing risk, as for household pet cats and kittens (Table 2). The retrovirus status of all cats should be known: vaccination is not a substitute for testing and isolation. Vaccination may be unnecessary if a good testing program is in place and no cats have access to the outdoors.¹³ If queens are routinely sent to another cattery for breeding, vaccination of breeding queens may be considered.

Rabies vaccination Cats in breeding catteries in the USA must be vaccinated against rabies according to state regulations. Elsewhere, vaccination against rabies is not generally recommended. Vaccinate if necessary by analyzing risk, as for household pet cats and kittens (Table 2).

Bordetella bronchiseptica and Chlamydophila felis vaccination The benefit of routine vaccination of cats in breeding catteries against these disease agents is limited. These vaccines should only be considered if the pathogens have been demonstrated as a current problem by laboratory diagnostics. When used, the primary series should be administered according to the manufacturer’s instructions, with annual revaccination if the problem remains endemic. In some countries, the manufacturer states that Bordetella vaccination is considered safe for pregnant queens. However, in other countries, datasheets advise that the vaccine should not be used in pregnant or lactating queens or in kittens less than 1 month of age.

FIP vaccination Vaccination of cats in breeding catteries against FIP is generally not recommended as there is insufficient evidence that the vaccine induces clinically relevant protection. (See accompanying Disease Information Fact Sheet – details on page 799.)

Dermatophytosis vaccination See earlier comments in the household pet cats section (page 791).

Vaccine adverse events

Although the administration of biological products can never be entirely free of risk, in general currently available feline vaccines have an excellent safety record. It is important to report any known or suspected negative events associated with vaccination, recognizing that a temporal relationship between an event and vaccine administration does not necessarily imply causality. In the United States, veterinarians are requested to contact the manufacturer (Veterinary Technical Services) of the vaccine(s) considered to be involved; veterinarians may also report known or suspected adverse events directly to the US Department of Agriculture. In other countries procedures may vary, but, in general, veterinarians should contact the manufacturer and notify the appropriate regulatory agency to report a vaccine adverse event (eg, the Canadian Centre for Veterinary Biologics [Canada]; the Veterinary Medicines Directorate [UK]; the European Medicines Agency [EU]. (See Appendix 1 [Adverse Event FAQs] on page 805 for specific reporting forms and instructions.)

The most commonly reported vaccine reactions are lethargy, anorexia and fever for a few days after vaccination, or local inflammation at the site of injection.^4,42,43 Rarely anaphylaxis is seen. Because vaccines are biologically active products, occasional adverse reactions associated with vaccination are inevitable. It should be recognized, however, that establishing causality is often difficult, especially if the suspected reaction is delayed (days or weeks).⁴³

Prevalence and type of adverse reactions

Although post-vaccinal adverse events in cats are considered rare, the true prevalence is likely to be underestimated due to under-reporting by both veterinarians and owners.⁴⁴ In the most substantial survey to date, adverse reactions were reported for all cats presented to Banfield Pet Hospitals in the United States between 2002 and 2005.⁴ During this period, more than 1.25 million doses of various vaccines were administered to nearly 0.5 million cats. Adverse reactions within 30 days of vaccination were reported at a rate of 51.6/10,000 cats vaccinated (0.52%), with 92% of these reactions occurring within the first 3 days. Clinical signs described for 1699 of 2560 cats with vaccination-associated adverse events included lethargy (± pyrexia) in 54%, local pain or swelling at the vaccine site (25%), vomiting (10%), facial or periorbital edema (6%) and generalized pruritus (2%). Death was reported in four cats, and in at least two of these it was attributed to anaphylaxis.

Although the vaccines used were predominantly from one manufacturer, no vaccine type was found to be significantly more likely to cause local reactions. Administration of multivalent FPV, FHV-1, FCV and Chlamydophila vaccines was significantly more likely to be associated with lethargy (± pyrexia) than administration of vaccines without the Chlamydophila component. The risk of an adverse reaction was greatest in cats around 1 year of age and/or increased as the number of vaccines administered concurrently increased.⁴ In another extensive study specifically investigating local post-vaccine reactions, a prevalence of 0.23% was reported.⁴⁵ Previous large studies have suggested adverse vaccine reaction rates of around 1–3%,^46–48 but some variation in prevalence can be expected with the use of different products, administration of multiple vaccines at the same appointment, and surveillance methods.

Hypersensitivity reactions

Anaphylaxis and allergic reactions

Anaphylaxis is perhaps the best characterized immune-mediated hypersensitivity (type I) reaction to vaccination, but it is rare (approximately 1–5/10,000 vaccines).^4,46 In cats it may manifest as vomiting, diarrhea, respiratory distress, facial or generalized pruritus, facial swelling and collapse.^1,43,49

A careful risk assessment is needed when considering the revaccination of cats with a history of anaphylaxis. In cats that have experienced an allergic reaction with true anaphylaxis, revaccination should usually be avoided. Vaccine excipients (inactive ingredients) are thought to cause most type I hypersensitivity reactions.⁴ Hence, where revaccination is considered necessary, using a different vaccine formulation and premedicating with an antihistamine and glucocorticoids 20–30 mins prior to vaccine administration is recommended, followed by close observation of the patient for several hours.^1,4

Depending on geographic location, the requirement to vaccinate cats for rabies may take precedence over medical considerations. Veterinarians are urged to contact the appropriate authorities to determine what the local status is when concerns arise and whether the individual may be excused from vaccination. (See also 2006 Guidelines, Appendix 1: Certificate of Exemption from Rabies Vaccination – details on page 786.)

Other reactions

While other forms of hypersensitivity reactions (types II, III and IV) almost certainly occur in cats after vaccination, these are rarely documented. Some forms of local reaction probably reflect type IV reactions. Polyarthritis is occasionally seen after FCV vaccination. Rarely it may represent a form of type III reaction, but it is mainly due to co-infection with field virus or vaccine virus itself.^50,51 (See Appendix 1 [General FAQs] ‘What is the cause of lameness occasionally seen after FCV vaccination?’, page 802.)

Update on feline injection-site sarcomas (FISS)

Vaccine-associated sarcoma was first recognized as an issue in cats in the early 1990s. While initial studies suggested a risk of sarcoma development in around 2/10,000 doses of vaccine administered,⁵² which increased to 13–36/10,000 doses in other studies,^53–55 current estimates based on larger epidemiologic studies (published between 2002 and 2007^4,45,56) suggest that the risk of sarcoma development following vaccination is actually very low (probably well below 1/10,000 doses of vaccine).^4,45

Although initial reports linked development of sarcomas at vaccination sites with the use of inactivated rabies⁵⁷ or FeLV vaccines,⁵² and aluminum-based adjuvants, more recent studies found no relationship between vaccine type, brand or use of inactivated versus modified-live vaccines and the risk of subsequent sarcoma formation.^56,58,59 The impact of using the canarypox-vectored rabies vaccine is still unclear. One retrospective study of histopathology samples showed no reduction in the prevalence of FISS after the introduction of this vaccine; however, the types of vaccine used were not reported.⁵⁸ In a recently published case control study it was suggested that there may be a lower risk of inducing sarcomas with this vaccine than with other rabies vaccines.⁵⁹ Many of these studies have also clearly shown that injections other than vaccines also have the ability to induce sarcoma formation.

No studies have been published that define objective methods for reducing the risk of FISS in individual cats presented for routine vaccination. Based on our current understanding of this problem, it is likely that vaccines are not uniquely implicated in the development of injection site sarcomas in cats.^56,60 FISS risk following vaccination likely results from a complex interaction of multiple extrinsic (eg, frequency and number of vaccines administered over time, composition of the injected product, etc) and intrinsic factors (eg, genetic predisposition, tissue response following injection, etc). The presumed relationship between types of vaccine, inflammation at the site of vaccination⁶¹ and subsequent FISS development appears complex at best and, if involved, is likely only one among many factors that contribute to FISS development.

Figure 6

While vaccines are not uniquely implicated in sarcoma formation, there are certain actions that can be taken to reduce the risk of FISS, as summarized in Table 5. Courtesy of Albert Lloret

Table 5 provides a brief review of considerations and management options for the reduction of FISS risk, taken from current publications. None of these suggestions are known to prevent or cure FISS.

Table 5

Summary of considerations and management options for FISS risk reduction

Action suggested	Objective	Comments
Recommend/administer vaccines on the basis of reasonable risk for exposure to the infectious pathogen	To avoid unnecessary vaccination of cats	Studies have suggested that the risk of FISS increases as the number of vaccines received over time increases^37,62–64
Administer vaccines only as frequently as needed to provide protective immunity	To avoid unnecessary vaccination of cats	Administer FPV, FHV-1, FCV no more often than every 3 years, except in high-risk situations^1,63
Administer parenteral feline vaccines by the SC route only	To facilitate early detection of tumor	Vaccine administered by the IM route does not reduce the risk of 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 removal by limb amputation in the event that FISS develops	See vaccination site recommendations on page 798
Consider vaccine type	To reduce the risk of chronic local inflammation at the injection site, which may occur in some cats⁵⁶	The role of adjuvants (including those containing aluminum) and local inflammation in the pathogenesis of FISS is not clear.^{52,57,61,64 –68} Both adjuvanted and non-adjuvanted vaccines induce local inflammation, 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’: the ‘3-2-1 rule’	To establish the presence or absence of malignant tumor formation as early as possible	Perform an incisional (vs excisional) biopsy if a lump: (a) persists for 3 months or longer after injection; or, (b) ever becomes larger than 2 cm in diameter; or, (c) continues to increase in size 1 month after injection⁵⁸
Perform additional assessment pre-surgically when FISS is confirmed	To evaluate the feasibility of attempting definitive treatment	Tumors are locally aggressive; thoracic metastasis occurs in over 25% of cases. Thorough pre-surgical evaluation of individual cases, including physical and laboratory assessment, thoracic radiography and other imaging as indicated, is recommended prior to surgical excision^63,69,70
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 oncologist^71 –75

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

When considering vaccine type, the Advisory Panel recommends that the following be taken into consideration. Recent studies demonstrate that all vaccines carry some risk of inducing FISS, as do at least some other injectable products. Although current information as outlined above does not clearly show differences in risk of FISS development between modified-live and inactivated vaccines, some Advisory Panel members consider that, on balance, risk might be mitigated by the use of modified-live vaccines. There are also other factors that may influence the choice of live versus inactivated vaccines (see Table 6 and Appendix 1 [General FAQs], page 803). Overall, however, the Advisory Panel concluded that, at the current time, there is insufficient information to make definitive recommendations to use particular vaccine types to reduce the risk of FISS.

Table 6

Indications for the use of inactivated vaccines in cats

Indication	Objective	Comment
Vaccination of pregnant queens	To avoid the risk of fetal/ neonatal infection with ML FPV	ML FPV may replicate in cerebellar tissue of fetal and/or neonatal kittens, leading to clinical signs associated with cerebellar hypoplasia¹⁹
Vaccination of cats known to be retrovirus positive	To avoid unlikely, but potential consequences of exposing an immune-suppressed cat to ML, replicating vaccine virus	The risks associated with administering ML vaccine virus to an immune-suppressed (retrovirus-positive) cat are unknown
High-density housing environments where upper respiratory infections are not known to be present	To avoid the risk of accidental or inadvertent oral/nasal exposure to ML FHV-1 and FCV vaccines	ML FHV-1 and FCV vaccine virus, if inadvertently aerosolized or inoculated by the oral or nasal routes, may cause upper respiratory signs associated with vaccine virus replication on mucosal surfaces
Rabies vaccine: when 3-year DOI is indicated or required	To provide licensed 3-year DOI	The only rabies vaccines currently licensed to provide 3-year DOI are inactivated vaccines

ML = modified-live, DOI = duration of immunity

Post-vaccination monitoring

The Advisory Panel recommends that clinicians and their staff instruct clients to monitor the vaccine site for swelling or lumps in order to detect potential sarcomas while they may still be removed successfully. Biopsy of any mass present is warranted if it (a) remains present 3 months after vaccination; (b) is larger than 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 are obtained to reduce the risk of harvesting non-representative biopsy material and to minimize the risk of tracking tumor cells outside of the future surgical field.

Figure 7

Administration of FPV, FHV-1, FCV vaccine subcutaneously below the right elbow. Courtesy of Dr Susan Little

Figure 8

Administration of FeLV vaccine subcutaneously below the left stifle. Courtesy Dr Susan Little

Figure 9

Administration of rabies vaccine subcutaneously below the right stifle. Courtesy Dr Susan Little

Figure 10

Regions indicated in green are recommended. Those in red are key sites that should be avoided. Image ©iStockphoto.com/GlobalP

Legal considerations associated with vaccination

Veterinarians in most countries are permitted to use professional judgment in the selection and use of licensed vaccines. Reference to these Guidelines, therefore, is appropriate when developing vaccination protocols for individual patients even though the guidance may vary from the manufacturer’s label recommendations or data sheet (eg, annual revaccination vs triennial revaccination for core vaccines).

Rabies vaccination of cats

Where rabies vaccination of cats is required, veterinarians may not have discretion to vary from the manufacturer’s recommendations or from requirements set forth by regulatory agencies. Rabies vaccination requirements vary from country to country and can vary significantly within individual countries. In locations where feline rabies vaccination is required by law, veterinarians are obligated to be familiar with and follow legal requirements when administering rabies vaccines. Rabies vaccination recommendations contained in these Guidelines do not constitute vaccination requirements.

Medical record documentation of vaccination

At the time of vaccine administration, the following information should be recorded in the patient’s permanent medical record:

Vaccine(s) recommended for this patient.

Date of vaccine administration.

Identity (name, initials or code) of the person administering the vaccine(s).

Vaccine name, lot or serial number, expiration date, and manufacturer of vaccine(s) actually administered.

Site and route of vaccine administration.

Concurrent medications/therapy.

Recommendations for future vaccinations.

Adverse events should be recorded in a manner that will clearly alert all staff members during future visits. Risks and benefits of vaccination should be discussed with the owner so that they can make an informed choice. Consent should be documented in the medical record to demonstrate that relevant information was provided to the client and that the client authorized the procedure.

Supplemental Material

Click here for Supplementary Material

disease information fact sheet: Feline herpesvirus 1

Supplemental Material

Click here for Supplementary Material

’The immune response to vaccination: a brief review’

Supplemental Material

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Pet Owner Guide

Supplemental Material

Click here for Supplementary Material

Pet Owner Guide (high resolution PDF)

Supplemental Material

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disease information fact sheet: Feline calicivirus

Supplemental Material

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disease information fact sheet: Feline panleukopenia

Supplemental Material

Click here for Supplementary Material

disease information fact sheet: Rabies

Supplemental Material

Click here for Supplementary Material

disease information fact sheet: Feline leukemia virus

Supplemental Material

Click here for Supplementary Material

disease information fact sheet: Feline immunodeficiency virus

Supplemental Material

Click here for Supplementary Material

disease information fact sheet: Feline infectious peritonitis

Supplemental Material

Click here for Supplementary Material

disease information fact sheet: Chlamydophila felis

Supplemental Material

Click here for Supplementary Material

disease information fact sheet: Bordetella bronchiseptica

Footnotes

Appendix

Acknowledgements

The AAFP would like to thank Boehringer Ingelheim for its sponsorship of these Guidelines and for its commitment to helping the veterinary community develop projects that will improve the lives of cats. Sponsorship does not imply endorsement of the sponsor’s products or services by the Association. The content of these Guidelines has been solely created by the Feline Vaccination Advisory Panel members. The sponsor has provided financial support directly to the Association and has had no role in the creation of content.

Conflict of interest

RBF consults with IDEXX Laboratories (Westbrook, ME), Merial Ltd (Duluth, GA) and Elanco (Greenfield, IN). RMG is a co-investigator on a project funded by MSD. KFH runs a shelter medicine residency program at UC Davis sponsored by Boehringer Ingelheim. JKL has worked with various pharmaceutical, vaccine and diagnostic test companies over the years to complete research studies, student and house officer training, to present at veterinary conferences, and to serve on expert advisory panels.

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2013 AAFP Feline Vaccination Advisory Panel Report

Abstract

Rationale:

Introduction

Vaccination principles

General information on types of feline vaccines

Risk/benefit assessment

Patient

Patient’s environment

Infectious agent

Recommendations for vaccination of household pet cats

Additional considerations when vaccinating household pet cats

Recommendations for vaccination of shelter-housed cats

Additional considerations when vaccinating shelter-housed cats

Recommendations for vaccination of cats in trap–neuter–return programs

Recommendations for vaccination of cats housed in breeding catteries

Additional considerations when vaccinating cats in breeding catteries

Vaccine adverse events

Prevalence and type of adverse reactions

Hypersensitivity reactions

Anaphylaxis and allergic reactions

Other reactions

Update on feline injection-site sarcomas (FISS)

Post-vaccination monitoring

Legal considerations associated with vaccination

Rabies vaccination of cats

Medical record documentation of vaccination

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Footnotes

Appendix

Acknowledgements

Conflict of interest

References

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