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Veterinarians Reclaiming Vaccinations

Immunization and herd immunity are critical parts of keeping horses healthy, but it takes knowledge to use them to their best effect.
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You—as the primary equine health provider—can reclaim vaccinations as part of your overall practice culture and as a means to improve your bottom line with proper client education.

With the advent of a plethora of sophisticated medical advances and available technology, it is not surprising that equine immunizations are no longer a mainstay of equine veterinary practice. Decades ago, vaccinations were one of the driving forces for getting practitioners onto clients’ properties to care for their horses. Yet immunization and herd immunity are still critical parts of keeping horses healthy.

Many horse owners still call their veterinarians for “spring shot” appointments. However, there are many horse owners who purchase vaccines from animal health retail outlets and administer the vaccines themselves. Some might forego vaccination altogether.

You—as the primary equine health provider—can reclaim vaccinations as part of your overall practice culture and as a means to improve your bottom line with proper client education.

Types of Vaccinations Needed

It is always good to be able to quote a reliable source when talking to horse owners about vaccinations. Horses should get the vaccines that they need for their locations, uses and exposure risks. The American Association of Equine Practitioners (AAEP) notes that there is not a one-size-fits-all vaccine program. Decisions about which vaccines to give are based on risk of disease, consequences of disease, effectiveness of vaccination products, potential for adverse reactions and the cost of immunization compared to the cost of disease.

Because the use of antibody titers or other immunological measurements is often inconclusive about effective protective immunity against specific diseases, it is not recommended to base administration of vaccine boosters on these tests. In other words, just because the animal tests positive for a titer doesn’t mean there is scientific proof it is protected against the disease.

One standard annual protocol recommended by veterinary organizations is the importance of administering core vaccines to every horse. AAEP and the American Veterinary Medical Association (AVMA) describe “core vaccines” as those “that protect from diseases that are endemic to a region, those with potential public health significance, required by law, virulent or highly infectious, and/or those posing a risk of severe disease.” For horses, these immunizations include:

  • Eastern and Western equine encephalitis (EEE and WEE)
  • West Nile virus (WNV)
  • tetanus
  • rabies

Every horse across the United States should receive each of these vaccines annually at a minimum. All vaccines—core or risk-based—begin with a primary series of two to three injections spaced three to five weeks apart (you can show horse owners the manufacturer’s recommendations if necessary). The vaccines are then boosted once or twice annually, depending on the timing and degree of exposure.

EEE, WEE and WNV are transmitted by mosquitos, so those might need twice-annual boosters in certain geographic locations. Rabies and tetanus only need to be given annually in most circumstances.

Besides the core vaccines, other vaccines might be relevant to give to client horses based on geographic location and risk. This is where your expertise and experience become even more valuable to your clients.

Vaccines are available for diseases that are more likely to affect traveling and competing horse populations, horses that congregate in large groups away or at home, or in special circumstances where a particular disease might be endemic. Recommendations to vaccinate against specific diseases are related to the risk of horses encountering exposure, during sudden outbreaks, or based on breeding disease risks, as some examples.

Risk-based vaccines that are available for horses include: 

  • equine influenza (EIV)
  • equine herpesvirus (rhinopneumonitis, EHV-1 and EHV-4)
  • equine viral arteritis (EVA)
  • anthrax
  • botulism
  • leptospirosis
  • Potomac horse fever (PHF)
  • snake bite
  • strangles
  • rotaviral diarrhea
  • Venezuelan equine encephalitis (VEE)

Two risk-based immunizations most commonly given on a regular basis are those that protect against equine influenza and rhinopneumonitis. To compete in FEI (Federation Equestrian International) or USEF (United States Equestrian Federation) events, competing horses must receive equine influenza at least twice yearly with proof of documentation of proper administration of a primary series and subsequent boosters. These vaccines must be administered by a licensed veterinarian.

FEI rules state: “Horses must be vaccinated against equine influenza in order to compete at FEI events. Every horse’s passport is checked at events to ensure that the horse has been vaccinated according to the FEI Veterinary Regulations; therefore, all equine influenza vaccines that have been given to the horse must be recorded in the horse’s passport.”

USEF also requires influenza and additionally requires proof of equine herpesvirus immunization. Since 2015, USEF policy states: “All horses entering the grounds of a Federation-licensed competition must be accompanied by documentation of Equine Influenza Virus and Equine Herpes Virus (Rhinopneumonitis) vaccinations within six months prior to entering the stables.”

Administration of others on the list of risk-based vaccines is wholly dependent upon presence of that disease in your area and each horse’s activity. For instance, a horse that lives in an irrigated pasture and only rides in an arena isn’t likely to need snake bite vaccine, but it might need protection against diseases carried by mosquitos that thrive in irrigation puddles.

For horses living along the border of Mexico, there might be value in immunizing against VEE. Breeding horses are more likely to receive EVA immunizations. Foals are candidates for rotaviral diarrhea and botulism vaccines. Horses residing near aquatic areas might benefit from leptospirosis or Potomac horse fever vaccines. Areas with known outbreaks of Streptococcus equi are more likely to necessitate immunization against strangles.

These risk factors help veterinarians decide what to immunize against and how frequently to administer those protections. They also are good points to share with clients when establishing which vaccines a horse should receive.

Some diseases—such as equine herpes myeloencephalopathy (EHM) or vesicular stomatitis virus (VSV)—don’t have specific vaccines available at this time. For those diseases, a veterinarian has an important role in educating clients about biosecurity measures.

The Benefits of Veterinarian-Administered Vaccinations

To achieve optimal client buy-in and vaccine protection, it is useful to educate clients about the benefits of having them administered by a licensed veterinarian. Vaccines must be kept under consistent refrigeration at all times to maintain their efficacy. Buying vaccines from a reputable source implies that they are kept appropriately under refrigeration and have not lost their potency. Warehouse or wholesale outlet companies, feed stores or veterinary bulk supply outlets won’t necessarily guarantee proper handling of these products.

It is important to impress upon clients that while they might feel like they are saving money by purchasing from sources other than a veterinarian’s office, they don’t have the assurance that their horse will receive adequate immunity if vaccinated with a poorly-maintained product. In most cases, there isn’t really any way to determine if a vaccine has lost its efficacy.

Veterinarian-administered vaccines provide more assurance that:

  • the vaccine comes from a reputable outlet;
  • the vaccine has been handled properly and kept at proper temperatures during the multiple transfers from manufacturer to the distributor to the veterinarian’s office to the horse;
  • the vaccine is not outdated;
  • the choice of vaccines is the most appropriate for each horse’s unique geographical location and riding/ competition pursuits.

Safe techniques used by veterinarians for administering vaccines offer the least risk to a horse and protect owners from being injured by a horse that objects to injections. Should transient side effects occur—muscle soreness, fever, malaise or an uncommon post-injection abscess—veterinarians can report these to the USDA and/or the manufacturer. In some cases, there might be financial compensation to the horse owner for significant illness events related to an immunization product if the product was administered by a veterinarian. This reporting and compensation process is not as likely to happen with owner-administered vaccines.

Adverse post-vaccination signs usually resolve within 48-72 hours. When the purest vaccine products available are used, fewer than 2% of horses have any sign of having been immunized. Based on the sheer numbers of horses immunized each year, veterinarians have knowledge of which manufacturers produce vaccines with the least likelihood of adverse reactions in individual horses.

Armed with knowledge that an individual horse has developed an adverse reaction from a previous vaccination, a veterinarian is able to administer an anti-inflammatory (NSAID) medication at the time of immunization to mitigate possible side effects. In some cases, a veterinarian can suggest separating out various vaccines to give at different times rather than immunizing with multiple vaccine products or multivalent products at one time. Or the veterinarian might recommend a different company’s product.

Insured horses might have requirements of veterinarian-administered vaccinations. Medications, including vaccines, have the potential to induce a health problem or life-threatening or fatal anaphylactic reaction. If that occurs and the vaccine (or medication) was not administered by a veterinarian, an insurance company might not honor the horse owner’s insurance claim.

Another benefit of veterinarian-administered immunizations is that you’ll know for a fact that certain illnesses aren’t likely to be part of a complaint when a horse isn’t doing right. This is especially important when considering rabies as a rule-out to a non-specific, acute problem. This gives peace of mind for both practitioner, horse owner and anyone who has come into contact with a sick horse.

Maintenance of a vaccination schedule is critical to ensuring optimal protection in an individual horse as well as maximizing herd immunity against infectious diseases. Veterinarians play a key role in ensuring that a primary series of immunizations and boosters are administered according to manufacturer protocols. Research has shown that lapses in vaccination are concerning when the primary course of immunization is interrupted and not completed or if a booster vaccination is not given annually or per manufacturer’s recommendations [Paillot, R.; Marcillaud, Pitel C., et al. Equine Vaccines: How, When and Why? Report of the Vaccinology Session, French Equine Veterinarians Association, 2016, Reims]. The report concluded that “Consequences of lapsed immunization is likely to be inversely proportional to the duration of immunity of the last vaccine administered.”

As part of the service of providing vaccines to client horses, vets schedule appropriate follow-up visits to the farm to administer vaccines according to the necessary schedule to comply with manufacturer recommendations. Older horses, especially those with PPID, might need more frequent boosters of certain vaccines. Equine practitioners have the ability to make those judgements based on an individual horse’s needs.

In the event of an infectious disease outbreak, veterinarians are informed by state veterinary officials of the presence of disease and the need for emergency vaccinations. In addition to disseminating this information to clients, equine veterinarians are able to advise clients about relevant biosecurity practices and surveillance to further keep their horses safe from a disease outbreak.

The Business of Wellness Includes Vaccinations

Preventive veterinary care with wellness exam visits can provide the best in health for your clients’ horses. In addition to providing good immunization and deworming protocols, the many little details of physical and behavioral health, dietary needs, dental care, soundness concerns and hoof care are considered and attended to at the time of a wellness exam. This maximizes each horse’s quality of life through prevention and early treatment of disease and enables the horse to give the best performance in its equine athletic pursuit.

This type of practice culture boosts clients’ appreciation of their veterinarians and inspires them to rely on their equine practitioners for advice and counsel.

There are many ways to market one’s equine veterinary practice. A wellness program rolls a bundle of services into one package with services that should be performed for most clients’ horses.

Some services included in wellness services are:

  • vaccinations twice a year, or as needed
  • deworming
  • fecal egg count
  • physical exams
  • body condition evaluation
  • nutritional consultation
  • EIA test
  • health certificate
  • microchipping
  • dental exam
  • dentistry with sedation
  • sheath cleaning

It is possible to set up varying levels of wellness programs that include some or all of these preventive care services. Ideally, all wellness programs should include vaccinations, fecal egg counts and deworming. Bundling these services, including vaccinations, into a specific program gives clients a “package” for using your services once or twice a year. In many cases, the package eliminates the ambulatory call charges, which decreases a horse owner’s financial outlay.

Being part of a wellness program also can make clients feel like they are receiving special attention. A wellness package can be customized for different horse age groups—pre-teen, teenage or senior horses—since different age groups might require different services and/or frequency of services.

Often, a wellness package is paid for in advance of the spring season, and this improves cash flow for a practice, especially during winter lulls in practice. Having a client sign up for this program also helps to spread out timing of services so some work can be performed during slower seasons rather than having it all piled up in the busiest months.

Ideally, a wellness package should generate 10-15% profit beyond costs of supplies, overhead, professional fees and veterinarian compensation.

An important feature of wellness packages is that they get the veterinarian onto the client’s property at least once or twice a year. This facilitates a practitioner’s ability to attend to more issues than just preventive care.

Equine veterinarians are trained to pick up subtle and obvious details about a horse’s health, which might necessitate further examination and testing while also affecting the timing of routine immunizations. Clients often have questions and bring up other concerns that have the potential to generate additional fees for additional work, such as lab testing, pregnancy evaluations or lameness exams, as a few examples.

BI vaccinations syndrome chart

Many equine issues are not identified by an owner and won’t be unless the horse is given a comprehensive veterinary examination. Research has shown that there are differences between owner-perceived health of horses and actual veterinarian findings, particularly in geriatric patients [Ireland, J.L., et al. Comparison of owner-reported health problems with veterinary assessment of geriatric horses in the United Kingdom. Equine Veterinary Journal Jan 2012; doi: 10.1111/j.2042-3306.2011.00394.x]. On this page are a few examples from that research (see chart above).

There is little doubt that under-recognition of problems results in delay of appropriate treatment. Educating clients about the possibility of early identification of health issues, including subtle changes associated with PPID, can help keep horses alive longer and with a better quality of life. Wellness exams provide an opportunity to identify issues in advance of major problems.

To motivate clients to sign on to a wellness program, you’ll need to advocate and communicate about this program verbally on the phone, in person, through your website, email notifications, social media, direct mailers and mailing stuffers that accompany billing invoices. Educate horse owners and trainers to recognize the value of preventing health problems—the results are healthier, more active horses that achieve better performance with fewer veterinary visits and costs.

Good communication between you and a client helps to inspire client loyalty while also enabling you to carry out a mission of improving health and quality of life for your equine patients. The trust and partnership that develop from an established relationship between veterinarian and horse owner keeps the lines of communication flowing well.

The Economics of Vaccination

There are several ways to look at the economics of vaccination. One is to ascertain how reclaiming vaccinations in your practice can affect your bottom line.

As described above, wellness exam packages are one way to market this service. Or you can simply schedule spring and fall immunizations with your clients through reminders sent via email, text or postal service. Every personal interaction with a client and his/her horse is an opportunity to identify other issues that can maximize horse health while generating more revenue.

Additionally, it is helpful to educate your clients about biosecurity practices to limit disease on a farm or while traveling. You also can educate clients about the value of herd immunity that is optimized through regular immunization programs of all horses at a farm or facility.

Another way of looking at the economics of vaccination is through the cost to the equine industry of morbidity and mortality related to outbreaks of disease. Not only is an infectious disease a major welfare concern, but it has significant economic implications.

The impact on the equine industry due to equine herpes myeloencephalopathy (EHM) outbreaks affects travel, training, competition and sales all over the nation. There is no currently available vaccine for this malady, but it serves to make a point about how an outbreak of infectious disease can shut down movement of horses for a lengthy period of time. This shutdown exacts impressive costs throughout the industry.

EEE, WEE and WNV are not contagious between horses, but they are associated with high mortality rates: EEE 90%; WEE 40-50%; WNV 30%. Hospitalization of a serious case can run $2,000-$5,000, with no guarantees of successful resolution.

Compare this with the cost of immunization of a horse for less than $150 to provide a primary series plus boosters [Humblet, M.; Vandeputte, S., et al. Estimating the economic impact of a possible equine and human epidemic of West Nile virus infection in Belgium. Euro Surveillance 2016, 21(31): pll = 30309; doi 10.2807/1560-7917. ES.2016.21.31.30309].

Horses surviving WNV often have persistent neurologic deficits, adding to economic losses of performance.

In the 2002 outbreak of WNV in Colorado and Nebraska, the financial impact based on laboratory-confirmed cases was sobering. A study by the USDA looked at the numbers [Economic Impact of West Nile Virus on the Colorado and Nebraska Equine Industries: 2002, published April 2003]:

  • total cost attributed to death or euthanasia: $600,660
  • revenue lost due to lost use (average of 22 days): $163,659
  • treatment costs: $490,844
  • vector (mosquito) control costs: not available, but likely were significant
  • vaccination costs: estimated to be at least $2.75 million for the two states

Vaccination against WNV is now a common component of spring immunizations. There are at least three products available with good efficacy against this virus. The cost of immunization pales in comparison to costs of individual horse morbidity, treatment, on-going deficits or death.

Australia experienced an intense outbreak of equine influenza (EIV) in 2007, with significant impact on the economics of their equine industry. Horses in Australia were generally not immunized against EIV, so a totally naïve population experienced significant morbidity (75,000 horses) over a five-month period. The Australian government spent the equivalent of $63 million USD for eradication of the virus and $164 million USD supporting the equine industry. These expenses were associated with movement restrictions, cancellation of equine events, and vaccination of at-risk horses. The disruption to all normal equine activities involved other incalculable costs, including loss of training, sales, breeding services and pregnancy rates.

A New Zealand article looked at the benefits of control strategies that implement routine vaccination against EIV [Rosanowski, S.M.; Carpenter, T.E., et al. An Economic analysis of a contingency model utilizing vaccination for the control of influenza in a non-endemic country. PLOS ONE Jan 2019; doi. org/10.1371/journal.pone.0210885].

Use of a suppression strategy, i.e. immunization of susceptible horses, provides an economic benefit:

  • Vaccination reduces the outbreak duration so horse activities can resume more quickly.
  • Trainers and owners benefit through the ability to continue working with their horses and engaging in competitive activities.
  • Sales of horses could return to normal more quickly with reduction in outbreak duration.
  • Breeding could return to normal more quickly with reduction in outbreak duration.

Not only does an infectious disease outbreak affect the general economy of the equine industry, but since racehorses and competitive sporthorses in all equestrian pursuits develop a commercial value based on their performance history, those values are diminished. For recreational horses, disease infection has an impact on a horse owner’s finances related to medical care of the horse and time lost in pursuit of equestrian activities. It also has an emotional impact for horse owners who view their horses as members of the family.

Take-Home Message

In decades past, horse owners and practitioners had to experience the heartbreaking events of horses suffering and dying from encephalitis, tetanus, rabies and other infectious diseases. Anyone witnessing such profound illness from one of these diseases isn’t likely to forget it and will strive to ensure immunization in all their clients’ horses.

Horse owners and equine practitioners take a lot for granted today due to the abundance of affordable and efficacious vaccines against deadly diseases and other infections that affect a horse’s performance or quality of life. Perhaps the approach has been too casual about an equine veterinarian’s role in ensuring that all horses are immunized for the core vaccines at the very least? Perhaps this is a good time to impress upon clients the value of effective protection and herd immunity.

The COVID-19 outbreak serves as a deadly reminder of what happens to a population when no vaccine is available. The message is loud and clear, and veterinarians can capitalize on the lessons learned during this human pandemic to inform and counsel clients about best preventive practices that include veterinarian- administered immunizations.

Vaccinating all horses in your practice helps not just your bottom line, but serves to maximize health of your equine patients and establish herd immunity that impacts the entire equine industry. 

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