Dr. Angie Krause (00:00)
Welcome back to Tails of Truth, where we tell the truth about veterinary medicine. I'm Dr. Angie, and this is JoJo, veterinary nurse extraordinaire. And today we're going to be talking about vaccine titers.

JoJo (00:14)
All right, yeah, you wanted to talk about this because you're doing a lot of them right now.

Dr. Angie Krause (00:18)
Yeah, for some reason things in practice always come in waves and I feel like all week I've just been reporting out vaccine titers. And for those of you who don't know what a vaccine titer is, it's basically just your pet's antibody levels to a virus we vaccinate for. And so we can test for rabies titers so we can see how much immunity

your pet has to rabies. We can do distemper and parvovirus for dogs and we can do panleukopenia virus for kitties.

JoJo (00:56)
I wonder if it's becoming more popular because people are doing more titers as there's measles outbreaks. So I wonder if people are becoming more familiar with just the opportunity to do titers.

Dr. Angie Krause (01:08)
I think so. You know, I got my measles titers done recently because I'm in the age group where they were like, I don't know. Like if you go on the CDC website or you know, anywhere else and living in Boulder County, I know there's a lot of Boulder County that's not vaccinated. And I don't want to be part of any of this outbreak if it ever happens here. And so I got my titers done and they were strong.

JoJo (01:12)
Did you? Yeah.

I just gonna ask, you're gonna share those results, right? I was curious, because I meant we must have been really young when we had those. So I do think that maybe people are, as a society, we're getting more educated around titers, and I love when people choose this option for their cats and dogs. Mm-hmm.

Dr. Angie Krause (01:34)
Totally.

Yeah.

You do.

Yeah. I mean, I think it's tricky. I, I feel kind of neutral about titers. Now I definitely use them for my, my sick patients, but it's hard because I, I get like this week I've, I think I've reported out four or five rabies titers and four or five distemper parvo titers. And the conversation that comes with them is always really tricky because we're just testing.

JoJo (01:50)
Yeah.

Dr. Angie Krause (02:12)
your pet's antibodies in this one moment in time, but I can't guarantee how long it's gonna stay that way, like how long those antibody levels are gonna be at that level. And we also don't have any studies that show that there's a certain level of antibodies needed to protect against the disease. And that makes it really tricky. Some people will say if there's any antibodies,

there should be protection. And some people say, no, that's not really true. We don't have any studies to prove that. Some immunologists will say it needs to be a certain amount. And so that, that's really tricky for me as the practitioner and to tell people what to do. And invariably, if you have a dog and you get parvo and distemper titers, the distemper titers always going to be lower than the parvo titer. And

And that's tricky because I vaccinated animals with a low distemper titer, like it's there, but I vaccinated them and we checked titers again and the body just does not seem or dog's bodies just don't seem to make as big of a response or create as big of a response. And so I think inherently there's, you know, some downsides because they're really expensive too.

JoJo (03:26)
Mm,

they they are so pricey. Well, and there's, I would say they're more invasive than a vaccine. You know, a vaccine is in and out 30 seconds, a minute, we'll give it a minute, right? But, you know, sending in a titer is collecting a sample of blood. So depending on your pet, that could be more traumatic than having a vaccination.

Dr. Angie Krause (03:29)
I see.

Right. If that.

Yes.

Definitely. Yeah,

and with vaccination, when these vaccines are created and the technology is created, we do challenge studies, which means that dogs are vaccinated with these diseases, or for these diseases with these vaccines that we're using, and then they're challenged. And that's how we know that these vaccines last for the duration.

JoJo (04:11)
When you say they are

challenged, do you mean they are then exposed to said disease that they were vaccinated against? Is that what you are speaking to? Okay. Yeah.

Dr. Angie Krause (04:17)
That's, yeah, that's correct. Thanks for clearing that up.

And so we can have a better idea of how long these vaccines last, but of course every immune system is different. And I've done a rabies titer at three years when, you know, technically the rabies vaccine should last for three years, but for the most part, we know that it lasts longer than that. We only licensed them for three years, sometimes one year, but right at three years, sure enough, I had a dog that...

her titer wasn't adequate and wasn't protective anymore. And so we had to revaccinate and you know, I've had some dogs seven years out still have an adequate titer. It's just tricky to know how often should I be checking those titers? If it's a high titer, does that mean I need to check it less often? If it's a low titer, does that mean I need to check it more often? And that's the part where we just don't know. And so.

JoJo (05:09)
Well now

I have so many questions about that. question number one, if I'm a pet parent, okay first of all, why is a pet parent typically performing a titer? I know there's not one answer for this, there's multiple answers for it.

Dr. Angie Krause (05:26)
I think it's usually to avoid the vaccine. know, people really want to avoid over-vaccinating, which is valid. Like, why would you want

JoJo (05:28)
Right.

Right, and we have found,

right, that we were, you know, the standard has changed over time since I've been practicing. The standard has changed. You know, what was one year can now be three years with some vaccinations. And so I can understand wanting to also be like, do I really need to do this? And some, I don't know, this was my other question. Are some diseases, not diseases, is it compounded? So the more vaccines your pet gets over a lifetime.

Dr. Angie Krause (05:40)
Mm-hmm.

JoJo (06:00)
is the value compounded, does that make sense? Are they taking on more and more and more?

Dr. Angie Krause (06:05)
does their immunity get better and better with each vaccine?

JoJo (06:08)
Right, like it. So if they've had 10 years of vaccines, I mean, is there a point that we might be able to go, you know what, they probably don't need any more vaccines for.

Dr. Angie Krause (06:18)
You know, yeah, I don't. It depends on the vaccine. So like a leptospirosis vaccine, which we can't check titers for that I know of, there's no commercial tests that I know of. We feel really confident that the antibodies to leptospirosis only lasts for about a year and maybe even a little bit less. so I, and we know that, you know, antibodies towards rabies lasts much longer.

JoJo (06:18)
10 to 15 years, you know, from age 10 to 15.

Right.

Dr. Angie Krause (06:45)
And so I think it really depends on what you're vaccinating for.

JoJo (06:49)
Right, okay. Well, let's just break them down into one. think that, because I can feel my mind going a million places with a million questions, so I wonder also if listeners are also having similar questions. So let's start with rabies, because I think this one is the trickiest in terms of, ⁓ let's just go with the law, right? It's trickier because there are laws in place for rabies, and because,

Dr. Angie Krause (06:50)
And so, yeah.

Yes.

Yeah!

JoJo (07:18)
The impact on a human, if rabies does occur, is detrimental, deadly. I was like, I don't wanna use the other D word, the deadly word, but that's the truth. going with, I mean, it feels extra risky to rely on a titer and the timelines of titers with rabies.

Dr. Angie Krause (07:25)
Yes, no one survives. No one's getting out alive. No, it's deadly.

Right.

Absolutely. And that's why I have pause with it. And it's not that I don't want to do it. And I understand why people do it, especially if their dog has an autoimmune disease or has previously reacted poorly to a vaccine. But if you find that your animal has interacted with a rabid animal, which just happened to me. So I'll tell that story in just a minute. But if you find that happening, the health department,

isn't going to care about that titer And it's possible that it could cost your dog or cat's life. And so they are of limited value. I think they have value. And I think for people that either don't want to vaccinate or can't vaccinate or shouldn't vaccinate, they do help us understand that this animal is probably protected, especially if we're camping or, know, that we're still protecting.

animal life and human life because like you said, there's no do over with rabies. It's uniformly fatal. And so I think it does have some value, but it has some serious limitations, which is hard for me as I, you know, my emailing my recommendations or reporting these out. It's hard to tell people what to do. And I never want people to feel so secure falsely because what if that is their pet? So

JoJo (08:55)
huh.

Dr. Angie Krause (08:59)
three weeks ago and I don't know have I told you my rabies story?

JoJo (09:02)
No, I have not heard your rabies story.

Dr. Angie Krause (09:04)
my gosh, this is big. First of all, we have to talk about this. ⁓ So it was about three, maybe four weeks ago. Time isn't real, but I got a call from a client at Boulder's Natural and they were like, I just found a bat in my house and it's dead and it flew into my house overnight. And I thought, no. So, you know, I called the health department, health department came and tested the bat and sure enough,

JoJo (09:07)
Okay.

Yeah.

Dr. Angie Krause (09:31)
that bat was rabid. And my patient who was in the house, I don't know how much interaction my patient had with the bat was up to date on that rabies vaccine. And I was so relieved because in that moment, my patient's life was in danger because if they tested that bat and it was positive and this animal wasn't up to date on the rabies vaccine.

JoJo (09:41)
Okay.

Dr. Angie Krause (09:56)
it is possible that they would elect to euthanize this pet. And so it definitely, has changed the way I feel about indoor animals and whether or not, you know, how important it is that they need to get vaccinated. But it also does make me feel less comfortable with just relying on titers alone.

JoJo (09:59)
correct.

Okay, for rabies. Well, and I wonder if in that household that happened to neighbors of ours before and the whole family had to get vaccinated or go through the rabies series, which apparently is really, really not fun to do.

Dr. Angie Krause (10:25)
They did.

No,

I hear it's awful. I've never had to do it because I'm vaccinated for rabies.

JoJo (10:31)
I've never, yeah,

I've not had to do it either. And the other piece of that I always think about, I don't know what the health department's protocol is, and maybe they take each situation patient by patient, or exposure by exposure, if you will, but they also have to then, do they still just perform a necropsy? Which necropsy is the autopsy version of another species. I realize we use these words sometimes that may not.

Dr. Angie Krause (10:56)
I

know, yeah.

JoJo (10:58)
Translate.

So I thought that that was a standard of like, it's through necropsy because it's in the brain tissue. that correct? Yeah. And that would be an extra layer of sadness if that were my pet. Yeah.

Dr. Angie Krause (11:02)
It's the only way to diagnose rabies. Yeah, it's in the brain tissue. Yeah, and so.

Right? Yeah.

And so I mean, I understand why we need them. And honestly, they're commercially available so we can import and export animals. Like if you take your pet to Hawaii, they need, know, Hawaii doesn't have any rabies and they feel really serious about keeping it that way, which is understandable. Well, no, you have to be vaccinated and have a titer. Like,

JoJo (11:32)
and they'll accept a titer.

Okay.

I was like, this is like new,

that's pretty loose. Okay.

Dr. Angie Krause (11:40)
No, no, no, no, they are not loose at all

with any of that. And so not only do you have to prove that your pet's been vaccinated multiple times, but you have to show the titer. And so we use these titers a lot for import export, but I, I hesitate to use them. And I understand it's not that, you know, I'm always happy to do it. If you want to come see me, I'm so happy to run a rabies titer. It's a little tricky for me to

tell you what it means, unless it's very low. And then I'm like, okay, then it's obvious that revaccination is recommended or if it's really high and you're like, oh, we're good. I don't know when to tell you to retest it. So I tell everyone just to retest once a year. And I feel bad because it's like, that's $500. Like if you were to do, if you're, a dog and you did rabies parvo distemper, that's like $500. So.

JoJo (12:09)
Right?

Yeah, it's not

cheap. That's just for the test. That's not for your visit and draw. Right, that's just for the test.

Dr. Angie Krause (12:37)
No, that's not for the visit. That's not for the draw. And then

and then it doesn't cover the vaccine if we get the results back. And then you.

JoJo (12:43)
right? Totally. I know those are

always like the fingers crossed, how's it going to come back, especially when people like, okay, I'm really tight on money. But this is what I want to do. Because there are dogs, and probably cats that have had severe vaccine reactions. And I think in those situations, there is no other choice. Right.

Dr. Angie Krause (12:53)
Right.

There is no other choice. Yeah.

And sometimes I even wonder why we're doing it then because you're like, what are we going to do?

JoJo (13:08)
Right, you're not gonna vaccinate. Right.

I guess there's just maybe the guardian could be a little bit more careful and exposure risk, like lifestyle risk. Yeah. man. Okay, so that was rabies. But I have another question about rabies before we move on to distemper for parvo. Because I we have seen over the last place since COVID, just this big shift in veterinary medicine and expecting that all pets have rabies vaccines before they come into the clinic.

Dr. Angie Krause (13:17)
Yeah, there's peace of mind and lifestyle. Yes.

JoJo (13:35)
or are getting up or coming in for a visit to be updated. I don't even know, does Boulder's Natural require that everybody be up to date on rabies? Okay, but most do. Most clinics do. And that's for risk too. Those are bite risks. That's really, think what that comes down to.

Dr. Angie Krause (13:44)
They do not.

Most do. Yeah. Yeah.

Yes, I think it's not that anyone thinks the average cat or dog coming in from someone's house has a high risk of having rabies. I think it's that when a nurse or a doctor or anyone in the hospital gets bit by an animal, which I mean happens not super regularly, hopefully, but it does happen that when we interact with the public health department, it's so that the animal doesn't have to go into a quarantine.

JoJo (14:12)
happens.

Dr. Angie Krause (14:24)
So in some ways it is protecting the dog or cat, but it feels like a pretty harsh policy. And now RISE, they will accept a titer. Yeah, which is nice. And I think it's a nice meat in the middle that they have done.

JoJo (14:36)
Okay.

There

are some daycares and groomers that will also accept hiders, but those are also so few between, they're hard to find. But there are. Okay, I think that covers rabies. Is there anything else you wanna say about rabies? Okay, distemper parvo for dogs. We're talking about distemper parvo in your canine companions. And I love how you mentioned, you know, one value is always.

Dr. Angie Krause (14:49)
Yes. Yes.

I don't think so. Yeah.

Yes.

JoJo (15:08)
higher or lower than the others, which, and the vaccine is typically a combo vaccine, so piecing that out is not so easy to do. So if your dog has, you know, really, they tend to have really high parvo titers, really low distemper parvos, we can piece out the parvo part of the vaccine, but that is not the one we ever need. Right, so it's kind of, yeah, it's kind of super tricky. And as you were speaking, I remember too,

Dr. Angie Krause (15:28)
No, it's never the one we need in Singular.

JoJo (15:35)
The lab used to put their recommendation on whether to vaccinate or not. And at some point in the last few years, the lab has decided not to do their recommendations anymore. So it's really on the vet to make the determination.

Dr. Angie Krause (15:39)
Yes.

Yeah, I miss those recommendations because I was protected by them. But yeah, I was like, I made this recommendation because Colorado State University said it was okay. And they're like, yeah, we're not now that people are doing this more often, we are not going to protect you with any kind of recommendation because we don't have the data to back this up. And I understand. And I think that's wise.

JoJo (15:54)
right right right it was in writing right yeah

Dr. Angie Krause (16:15)
because distemper virus is often fatal. Like that is a really bad virus. Parvovirus is fatal in some cases and not always in others. It really depends on the age and size and breed of your dog and how much money you have to be honest to get them through. But we have better and better treatment for parvovirus. But I mean, neither one of these viruses are ones you want your dog to have ever. And so it is tricky. The distemper thing is tricky. ⁓

Um, they don't make monovalent distemper virus vaccines anymore, where it's just the distemper. And so that's why it's a little bit hard. like, well, we can, we, I can spend $150 of your, you know, $150 of yours and we can check. then when the distemper is going to be low, we're going to, then you have to decide. I think what it does is I feel like I keep putting this big

complicated decision back on the pet lover. And I feel a little guilty about it because that's complicated to understand all of those.

JoJo (17:18)
Yeah, but if

they're like me, I love data collection. So yeah, give me the data and then I can make my choices from there.

Dr. Angie Krause (17:23)
You want that data, yeah.

Okay, okay. Well, maybe I need to let go of that. But doesn't it just feel like when you think about the immune system, it's so complicated that, I don't know, it's hard to make a recommendation.

JoJo (17:39)
Right, and yeah, is. I was gonna go into my own story of how I come to decisions, but that's not necessary. I just think that, yeah, some people might just really like, it might make them feel more solid in the decisions they make because vaccines are really hard for some people to get behind. we have been, I mean, there's truth that people and pets have been injured by vaccines. That is fact.

Dr. Angie Krause (17:46)
Okay.

Yes.

Yes.

JoJo (18:04)
and people and pets have been saved by vaccines, that is fact. So ⁓ it's okay, I see it a lot that people come in and they have their own experience with vaccines. And so there's sometimes a lot of hesitation and I think having that data can help them come to a decision that feels really aligned for them.

Dr. Angie Krause (18:07)
Yes.

Absolutely.

And I did report out a couple of titers. I'm like, everything looks good. Let's recheck next year.

JoJo (18:27)
Yeah, exactly. That and that

would feel so good to me if I got one of those where I was like, okay, we can just push it off another year. That's what you know, over a lifetime of my dog, that might be, you know, one or two less vaccines that he has to get. ⁓ I totally I think it's harder. And when I said I love that people come in for this, I do love that people come in for because I love people who are collecting information. ⁓

Dr. Angie Krause (18:35)
Yeah.

Right. Totally.

JoJo (18:55)
But I think it is really hard with rabies. I think it's less hard with distemper parvo because that's just in me where I've settled like, okay, if one of them slow, then I'll continue to vaccinate.

Dr. Angie Krause (19:04)
right. And then let's not forget about cats. Cats and the panleukopenia. So your veterinarian always offers or probably recommends an FVRCP vaccine or a feline distemper vaccine, that's called either one. And it has some upper respiratory viruses. And it also has panleukopenia, which is a terrible virus that is usually fatal to cats. But

JoJo (19:06)
Right.

Dr. Angie Krause (19:28)
cool thing about panleukopenia is if your cat has had a few kitten vaccines and maybe one or two as an adult, they're usually protected for life from panleukopenia. And so for those that don't want to vaccinate their cats, but maybe their cats indoor outdoor, or more importantly, if they're fostering or if they're going to be, if their cat's going to be exposed to a lot of kittens, like letters of kittens coming through, cause that's usually when we see panleukopenia.

I like to be able to check in and see that my patient has a protective titer and usually it's protective for life. So that's not one that I have to keep checking in on.

JoJo (20:06)
Another situation where that might be useful is if you get, if someone were to get a cat off the street or, you and not knowing their vaccine history, sometimes that's where titers can also across the board come in really useful is when you don't know a vaccine history, you could run a titer to find out, okay, they have been vaccinated at some point and then build a timeline for the next vaccination with your veterinarian.

Dr. Angie Krause (20:13)
Yeah.

Yes.

rate.

Totally.

JoJo (20:30)
But the panleukopenia, so if they didn't test positive, if they didn't have positive antibodies for that, is the only option the *three* in one vaccine? Okay.

Dr. Angie Krause (20:40)
Yes,

there's no monovalent panleukopenia vaccine on the market. Yeah. And you know what? Most cats do really well. Cats are, we just have to take a moment to talk about cats rarely have vaccine reactions, knock on wood. Cats are on some level so much less sensitive than dogs. So just a shout out to the cats.

JoJo (20:45)
Yeah. Okay. Hold on.

Yeah, well, I was gonna say you could

also go back to one of our very first episodes where we talked specifically about vaccine sarcomas in cats. So we in a length go through what vaccines are available to your cat, how you can make really, how you can advocate around the type of vaccine and where that vaccine is given. It's a whole episode for cats and vaccines. Yeah.

Dr. Angie Krause (21:10)
Right.

Right. It's a whole, yes, it's

really important. Gotta get that ⁓ Pure Vax low on the leg. Yeah, yes you don't.

JoJo (21:31)
Mm-hmm. Okay, that

was way more fun than I expected talking about titers, but I love that.

Dr. Angie Krause (21:37)
Yay. Antibody

levels. So if you have any comments or questions, you can leave them wherever you're watching this. I'm pretty sure. If not, go to YouTube. I know for sure you can always leave them on YouTube, but we would love to hear from you. And if you're listening to this, you can go to boulderholisticvet.com and go to our course section. What's it under now, JoJo? We have a completely new website. What do they click on?

JoJo (22:03)
Well,

oh, I think at the very top bar, yeah, it says learn more and you can find all the courses in one place.

Dr. Angie Krause (22:05)
Learn more?

Yeah, so then you can go to learn more and then courses and then you can grab any one of our courses for free using the code.

JoJo (22:19)
truth tales and you can spell tails

however you would like. Angie's going to learn this by episode 30 TA ILS or TA LES and then grab one of our courses and there is one on vaccines in there.

Dr. Angie Krause (22:32)
Yes.

There is, yes. So you can learn more about that or anything else you want. And we'll see you next time. Bye.

JoJo (22:41)
next time.