2020 AAHA/AAFP Feline Vaccination Guidelines: Executive Summary and Key Points

The 2020 AAHA/AAFP Feline Vaccination Guidelines provide the most current information and recommendations for feline vaccination as determined by a task force of experts in feline practice. The recommendations are based on current peer-reviewed literature and data, and complemented by clinical insights collectively derived from decades of experience. This executive summary provides selected highlights of the guidelines.     

by Constance Hardesty, MSc

Note: This executive summary provides selected highlights of the guidelines. It is not a replacement for reading the guidelines in their entirety. The 2020 AAHA/AAFP Feline Vaccination Guidelines (published in issue 56.5 of the Journal of the American Animal Hospital Association) provide the most current information and recommendations for feline vaccination as determined by a task force of experts in feline practice. The recommendations are based on current peer-reviewed literature and data, and complemented by clinical insights collectively derived from decades of experience.

The guidelines update the 2013 AAFP [American Association of Feline Practitioners] Feline Vaccination Advisory Panel Report and utilize similar recommendations from the 2016 WSAVA [World Small Animal Veterinary Association] Guidelines for the Vaccination of Dogs and Cats. Both of these previously published resources should still be considered relevant and actionable complements to the 2020 AAHA/AAFP guidelines.

The 2020 AAHA/AAFP Feline Vaccination Guidelines continue the established approach of considering inclusion of core (recommended for all cats) and noncore (recommended based on an individualized risk-benefit assessment) vaccines in an individualized protocol.

Summary

Vaccination protocols for cats should consist of recommended core vaccines and discretionary noncore vaccines as defined and listed in the guidelines.

Noncore vaccines are given based on a risk-benefit assessment. Risk is determined by the patient’s life stage, lifestyle, place of origin, clinical history, and health status and by environmental and epidemiologic risk factors that determine the likelihood of infectious disease exposure and susceptibility.

Although feline vaccination is universally practiced by primary care companion-animal practices, there is no single protocol suitable for all feline patients. Rather, vaccination of cats should be patient specific and guided by an individual risk-benefit assessment using the criteria listed in the guidelines.

In the case of some vaccines, practitioners have a choice of different types of antigens, including those that are inactivated, attenuated, and in recombinant form. The patient’s clinical and vaccination status, such as the possible presence of maternally derived immunity or a history of adverse postvaccination reactions, are factors that may influence the choice of vaccine type.

Although most feline patients are household pets, practitioners should anticipate situations in which higher-risk cats are presented for vaccination, including those from shelter, cattery, feral, or foster care origins.

Adverse postvaccination reactions unavoidably occur in a small percentage of cats. At the time of vaccination, relevant information about the vaccination should be recorded, as detailed in the guidelines.

Because of their neoplastic etiology, feline injection-site sarcomas (FISSs) continue to be the most serious, if infrequent, vaccine-associated adverse event. Detection of patterns in FISS incidence remains elusive, and their occurrence continues to be idiosyncratic. Advising clients in advance of the possibility of hypersensitivity or other reactions will help minimize their concerns.
Staff education initiatives should enable the veterinary practice team to be proficient in advising clients on proper vaccination practices and compliance. The practice should designate a person to be the primary vaccine coordinator for the facility.

Vaccination Principles

As part of a routine wellness program, the vaccination needs of all cats should be assessed annually, in conjunction with a comprehensive physical examination, modifying vaccination and other control recommendations as necessary based on the current risk (see the “Vaccination Risk-Benefit Assessment” section in the guidelines).

The quality of vaccine-induced immunity is influenced by the patient’s environment, the characteristics of the vaccine, the pathogen, and the patient’s immune competence. The risk of infection and disease varies with factors such as the age and health of the cat, magnitude of exposure to the infectious agent, the pathogenicity of the agent, and the vaccination history of the cat.

Some of the factors that influence an individual animal’s ability to respond to vaccination include interference from maternally derived antibodies (MDAs), congenital or acquired immunodeficiency, concurrent disease, inadequate nutrition, chronic stress, and very young or old age. Some vaccines (e.g., those for feline panleukopenia virus) induce a stronger protective response than others (e.g., those for feline herpesvirus type 1).

ecause vaccine-induced protection is variable and not absolute, vaccination should not be used as the only form of protection, and other control measures, such as those that reduce exposure to infectious agents, should also be employed. It is important to inform cat owners that vaccination is not a guarantee of protection.

Care for Kittens

In general, kittens are more susceptible to infection and disease than adults.
Kittens born to immune queens absorb specific MDAs through colostrum. Although MDAs provide important protection during early life, the persistence of MDAs is one of the most common reasons for vaccine failure.

The amount of MDAs in a kitten at any one time cannot be predicted because it varies depending on the titer of the dam and the amount of colostrum ingested after birth. The guidelines’ discussion and recommendations for vaccination of kittens are too lengthy to reprint in their entirety in this executive summary. It is essential to carefully read the guidelines in full for the task force recommendations. However, one key change is the recommendation to revaccinate kittens against feline panleukopenia virus, feline herpesvirus type 1, and feline calicivirus at 6 months of age to potentially reduce the window of susceptibility in kittens with MDAs toward the end of the kitten series (16–18 weeks).

Types of Feline Vaccines

Vaccines, including those from different manufacturers that are licensed to protect against the same pathogen, should not be assumed to be equivalent. The processes and technology used to produce vaccines, the additives (such as adjuvants) used, and the route of administration—all of these factors influence the efficacy, safety, and duration of immunity. The attributes of the three types of feline vaccines—inactivated, attenuated live, and recombinant—are listed in Table 1 of the guidelines.

Core, Noncore, and Not Recommended Vaccines

The heart of the guidelines is a series of tables that detail recommendations for core, noncore, and not generally recommended vaccines for pet cats as well as core and noncore vaccines for shelter cats. (See Tables 2–5 in the guidelines.) The task force supports the WSAVA’s recommendation that veterinarians should vaccinate every cat with core vaccines and give noncore vaccines no more frequently than necessary.

At a Glance

To support individualized recommendations for feline vaccination, these guidelines provide discussion and recommendations for practice teams. Objectives include:

  • emphasizing the individualized approach to vaccination based on a risk-benefit assessment
  • discussing several factors to consider in creating an individualized vaccination plan, including life stage, lifestyle, and environmental risk factors
  • providing detailed guidance on kittens, recognizing that maternally derived antibodies may interfere with immunization
  • listing, in easy-to-reference tables, approved core, noncore, and not generally recommended feline vaccines and the relevant considerations for their use
  • assessing current research about vaccine safety, including discussion of feline injection-site sarcomas
  • describing the role of the practice team in educating clients about the practice’s individualized approach to vaccination, with talking points for client conversations
  • offering an online lifestyle-based vaccine calculator to help veterinarians create the plan

Creating an Individualized, Lifestyle-Based Vaccination Plan

The decision whether to administer a vaccine to a cat, and how frequently, relies on an individual case-by-case assessment by the veterinarian. This involves consideration of the animal, the animal’s environment, and the pathogen in question. Additionally, risk-benefit assessments should consider the safety of the vaccine, other adverse effects of vaccination, and the efficacy of the vaccine.

As presented in the guidelines, there is some overlap in the information required for the risk-benefit analysis and the lifestyle-based vaccination plan. Refer to the guidelines for the full range of information required for each. Some takeaways include:

  • The vaccination needs of each cat should be evaluated individually and rationally, based on health status, age, and possible, realistic exposure to disease. (See Table 6 in the guidelines for more details.)
  • Special consideration is needed for kittens, young cats, and cats entering boarding, breeding, foster, or shelter situations.
  • Each cat in a multicat environment must have a vaccination plan that balances the protection of the individual with that of the larger population.
  • The individualized, lifestyle-based vaccination plan must be reassessed at least yearly or when changes in health and lifestyle occur. This requires client education and at least yearly veterinary visits.

AAHA’s lifestyle-based vaccine calculator uses a cat’s life stage and lifestyle information to suggest an appropriate, individualized vaccination protocol. 

Serology and Diagnostics

Table 7 of the guidelines lists possible uses of in-clinic serology testing.

Adverse Postvaccination Reactions

The guidelines encourage reporting of adverse events and provide contact information for doing so.

At the time of vaccine administration, include in the patient’s permanent medical record the name, serial number, expiration date, and manufacturer of the vaccine given; the date of administration; the name of the person administering the vaccine; and the site and route of the vaccine administration. Adverse events should be recorded in a manner that will clearly alert all staff members during future visits.

The guidelines discuss the prevalence and types of adverse reactions and suggest the 3-2-1 rule for monitoring the vaccination site for swelling or lumps. Biopsy of any mass is warranted if it remains present 3 months after vaccination, is larger than 2 centimeters in diameter, or is increasing in size 1 month after vaccination.

Update on Feline Injection-Site Sarcomas

This lengthy section of the guidelines covers observations and recommendations on vaccination sites and FISSs, reference to recommendations from the 2013 AAFP Feline Vaccination Advisory Panel Report, and an analysis of current research about vaccine safety. Some key takeaways include:

  • Much remains unknown about FISSs.
  • Neither vaccinating in the interscapular space nor decreasing the vaccine volume is recommended.
  • Recommended injection sites are shown in Figure 1 in this summary and on page 261 of the guidelines.

The 2013 AAFP report recommended that specific vaccine antigens be administered at specific anatomical locations in the distal limbs. This has helped to facilitate identification of the vaccine antigen used if a sarcoma develops at the vaccination site. The task force recognizes and supports this recommendation while recognizing that practitioners may need to use discretion. Practitioners are strongly advised to keep complete, accurate records of antigen administration site and route of vaccine administration.

Frequently Asked Questions

More than 50 questions commonly asked by practitioners have been compiled and answered by task force members.

Staff and Client Education

The healthcare team, led by the veterinarian, is part of a team approach to vaccine management. This requires understanding of zoonotic disease, and of core and noncore vaccines as determined by the pet’s lifestyle, hospital policy, state law, client compliance, and adverse vaccination events.

A veterinarian should assess every patient regardless of appointment type for current vaccination status based on age and lifestyle. Informed by this assessment, an individualized patient vaccination plan should be developed or modified and then discussed and agreed on in collaboration with the cat owner.

In addition to overseeing the development of feline vaccination protocols, the veterinarian should provide staff education on several topics, which are listed in the guidelines. The Centers for Disease Control and Prevention (CDC) online training module “You Call the Shots: Vaccine Storage and Handling” is a useful resource for staff training on vaccination.

The practice should designate a person to be the primary vaccine coordinator for the facility. This person will be responsible for ensuring all vaccines are stored and handled correctly. A second staff member should be appointed to serve as an alternate in the absence of the primary coordinator (this is particularly important in case of after-hours emergencies). Both coordinators should be fully trained in routine and emergency policies and procedures.

Credentialed Veterinary Technician or Veterinary Assistant Roles and Responsibilities

A veterinary technician or assistant often assumes the role of designated vaccine coordinator, assisting in vaccination storage and inventory management. AAHA guidelines on vaccine storage and handling and the CDC Vaccine Storage and Handling Toolkit are useful resources for this purpose.

The vaccine coordinator is often responsible for:

  • reconstitution of vaccines and administration of vaccinations as directed by the attending veterinarian in compliance with state law
  • implementing feline-friendly handling techniques
  • maintaining effective client education and follow-up, including verbal and written instructions on potential adverse events after vaccine administration and disease prevention
    See the guidelines for additional details.

Find It Online

AAHA’s lifestyle-based vaccine calculator uses a cat’s life stage and lifestyle information to suggest an appropriate, individualized vaccination protocol. 

The AAFP offers disease information fact sheets.

Roles and Responsibilities of Reception and Other Client-Service Personnel

The reception staff is typically charged with maintaining patient files with vaccination information, including date administered, along with the production lot serial number and expiration date of the vaccine. Reception personnel are also responsible for contacting clients and scheduling follow-up appointments for booster series and yearly vaccinations in advance as directed by the prescribing veterinarian. Nonclinical staff should understand the potential life-threatening and minor adverse events that can occur following vaccination that require veterinary assistance.

Client Education

The most significant issue to consider regarding vaccination of pet cats is the individual cat’s exposure risk and exposure frequency to other cats and feline infectious diseases. Even indoor cats from single-cat households will inevitably be exposed to other feline infectious pathogens in situations such as a veterinary hospital visit, contact with other cats entering the premises, or exposure to contaminated fomites introduced by human contact. Client education for owners of these patients should focus on risk of exposure to other cats rather than on where the cat eats, sleeps, or spends most of their time.

For high-risk, multicat households, the probability of infectious disease exposure and transmission is proportionate to the number or density of cats on the premises. It is important to educate clients about the increased disease risks to this population of cats and to discuss increased owner responsibility to ensure appropriate preventive healthcare initiatives associated with housing many cats in a confined space.

The guidelines include some talking points for client education. In addition, AAHA and the AAFP offer client handouts. 

Constance Hardesty
Constance Hardesty, MSc, is an award-winning writer specializing in science, medicine, and technology.

 

Photo credits: ©iStock.com/disqis, ©iStock.com/raw, ©iStock.com/GlobalP

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