Q16: Do you get dogs that solely show respiratory signs or would you always expect to see some evidence of renal or liver issues too?

C: See question 8.

Q17: Did you run clotting factors before doing the biopsy?
C: Yes, I always check a platelet count and coagulation times before all liver biopsies.

Q18: Have you seen leptospirosis in any exotics?

C: I don’t see exotics at all, so my experience is very limited. From a rapid search of the literature, leptospirosis can affect hamsters, guinea pigs and rabbits, and most mammals can probably be affected.

Q19: What dose of amoxicillin-clavulanate would you use for the treatment of leptospirosis?

C: I would use amoxicillin-clavulanate 20 mg/kg intravenously every 6-8 hours. Penicillin G can also be used as an injectable antibiotic if amoxicillin-clavulanate is not available (dose: 25,000–40,000 units/kg IV or IM q12h). These antibiotics will NOT clear the renal carrier status and it is essential that a course of doxycycline is administered afterwards. Once the dog can tolerate oral medication, I would change to doxycycline (see question 12 for dose).
Q20: Is leptospirosis transmissible to exotic pets?

C: See questions 18.

Q21: Intranasal administration of Parainfluenza uptake can be low and DHP is used with L4. What level of risk is perceived about the increase in parainfluenza incidence?

C: Both vaccinations against canine parainfluenza and leptospirosis are non-core vaccines and vaccination of an individual dog should be based on risk assessment. I would say that in the UK, dogs may well be exposed to both. Parainfluenza alone should only cause a self-limiting cough with laryngitis, tracheitis, and possibly a serous nasal discharge; the clinical signs should resolve spontaneously. However co-infection with Bordetella bronchiseptica or another respiratory viruses, especially in puppies, can cause an extended and potentially serious clinical disease, so vaccination is usually recommended. Leptospirosis can be life-threatening. So ideally a dog in the UK should be vaccinated for both leptospirosis and parainfluenza, especially puppies. If only one vaccine can be given, I’d base my choice on the lifestyle of the dog (exposure to rodents/wildlife, hunting, living in a rural location and access to water increase the risks of leptospirosis; canine parainfluenza virus is usually transmitted with direct contact with an infected dog, so meeting lots of other dogs increases the risk of parainfluenza infection).

An intranasal vaccine should be preferred rather than a subcutaneous injection for parainfluenza as local mucosal immunity is most important in protecting dogs from infection, and intranasal vaccines will give a better local immunity. I would highly recommend using an intranasal vaccine for parainfluenza and a parenteral vaccine for leptospirosis.

Q22: Would there be a need for the Nobivac L4 vaccine in the highlands of Scotland?

C: It is difficult to tell as I cannot find any data on the seroprevalence or disease incidence in dogs in Scotland. If you see cases of leptospirosis in dogs vaccinated with a bivalent leptospirosis vaccine, it is likely that non-vaccinal serogroups are present in the area. I would also consider that more and more people travel with their dogs for holidays etc, and we know that there are serogroups other than Icterohaemorrhagiae and Canicola in England and many other European countries, so I would recommend a quadrivalent vaccine for any dog that may travel outside of Scotland.

Q23: Do adult dogs need two vaccine injections at boosters?

C: For the Nobivac L4, adult dogs need two injections when they receive the L4 for the first time, then after that it is one injection yearly.

Q24: If in-contact dogs need treatment, do in-contact humans also need treatment, including vets & nurses? Are most vets protected by vaccine syringe stick injuries?

C: I cannot really recommend human healthcare measures. But I have never been treated prophylactically. The numbers of vets with antibodies against Leptospira in studies remain low, and disease transmission is unlikely if strict barrier nurse is applied. Also doxycycline can have unpleasant side effects in humans (gastrointestinal mostly). At my clinic, we warn all staff and clients who have been in contact with a dog suspected to have leptospirosis or diagnosed with leptospirosis that they should contact their GP and tell them about it if they become ill in any way, particularly with flu-type signs. But we don’t recommend seeing their GP if they remain healthy. I once got the flu myself 2 weeks after contact with a dog with leptospirosis, and I was tested for leptospirosis (negative) and treated with doxycycline, but that was because I had clinical signs.

I think that a needle stick injury with a syringe containing a vaccine for leptospirosis is very unlikely to give a human a sufficient dose of antigen to be protected against leptospirosis. Canine vaccines have not been assessed in humans, so even injection of a full dose may not induce immunity in a human.

Q25: What would be an ideal vaccination schedule for a puppy?

C: This is a tricky question and I would base myself on recent published vaccination guidelines such as the WSAVA guidelines rather than vaccine manufacturer recommendations. The WSAVA vaccination guidelines, as well as a summary for owners, can be accessed for free (http://www.wsava.org/guidelines/vaccination-guidelines). Below are my recommendations for a normal companion puppy in the UK. Other recommendations would apply in higher risk situations (shelters, breeders, kennels, hunting dogs) or different locations.

In the vaccine guidelines from the WSAVA, it is recommended that puppies should have their last puppy vaccination at 14-16 weeks of age (same for kittens), then first booster at one year. A number of puppies receiving their last vaccine at 10 or 12 weeks will actually not be covered until their 1-year booster, due to maternal antibodies. Very few practices in the UK seem to follow those guidelines though, and we don’t seem to see that much parvovirosis in vaccinated puppies that finish their vaccines at 10 or 12 weeks, but that doesn’t mean that these puppies are appropriately protected. Distemper and adenovirus hepatitis are rare (although there were a couple of cases of distemper in some puppies in Wales recently), but again puppies receiving their last vaccine at 10 or 12 weeks may not be appropriately protected.

If I had to devise a vaccine protocol for puppies in the UK, I’d vaccinate at 8, 12 and 16 weeks for all the viruses (distemper, hepatitis and parvovirus, DHP). If a puppy comes in at 6 weeks, I’d probably either wait until 8 weeks to vaccinate (do worming and flea treatments etc only at 6 weeks), or vaccinate at 6, 12 and 16 weeks (6 weeks instead of 8), unless they are at high risk (living in a kennel or shelter, or outbreak of parvovirosis/distemper in the area), in which case I’d do DHP every 2 weeks until 14-16 weeks old.

For leptospirosis, I would use a quadrivalent vaccine (ie Nobivac L4). The WSAVA guidelines recommendations are to vaccinate initially at 12-16 weeks for leptospirosis, with a second dose 3-4 weeks later. So I would vaccinate at 12 and 16 weeks for leptospirosis. Vaccination against leptospirosis could potentially be done at 6 or 8 weeks, then at 12 and 16 weeks (so starting earlier and with 3 injections) if the risk of exposure is high (leptospirosis outbreak in the area).

For kennel cough, I would recommend using an intranasal vaccine containing parainfluenza and Bordetella bronchiseptica (intranasal vaccines are recommended to give better local mucosal immunity), and I would vaccinate puppies at 8 and 12 weeks. While manufacturers usually recommend only one dose, the WSAVA guidelines recommend administration of two doses in puppies for best results. Revaccination in adult dogs is only recommended if they are at risk (frequent contact with other dogs) and is yearly.

Very importantly, I would NOT recommend waiting after all the full primovaccination course for socialisation. During that vaccination period, until 2-3 weeks after the final vaccine (which per guidelines should be given at 14-16 weeks), there will be a number of puppies that are not protected from disease. Waiting until 16-18 weeks old to socialise would be very detrimental and dangerous. The risks of puppies getting a vaccinal infectious disease is low if they are being socialised with humans, cats etc, and with dogs that are healthy and vaccinated (including puppy parties, which I’d start at least 2 weeks after the first vaccine injection is given, so at around 10 weeks old if I start vaccinating at 8 weeks). Places with like streams, rivers, lots of wildlife or rodents, or lots of unknown dogs or their faeces should be avoided until the puppy is 16-18 weeks old (2-3 weeks after final vaccines). The risk of getting leptospirosis and other diseases should then be low (unless in situations like local outbreak, crowded conditions etc where vaccines can be given every 2 weeks until 14-16 weeks). Any puppy younger than 16-18 weeks and becoming ill can have a disease against which we vaccinate and this should be explained to owners; owners should be told to seek veterinary attention straight away if the puppy becomes ill.

Finally I consider that vaccination against Borrelia burgdorferi and canine coronavirus are not recommended.