OHC 5 vaccine site reactions

Question 1

What are the allergic or immune mediated reactions?

Answer 1

1. Type 1: IgE mediated. Angioedema (swelling of head and ears), urticaria (hives), acute onset diarrhea, collapse, vomiting, shock and death. Within first 24 hours of vax being given.
   
   2. Type 2 (IgG and IgM mediated). Immune mediated hemolytic anemia (IMHA), and immune mediated thrombocytopenia (ITP). Weeks or months after vaccine was given.
   3. Type 3 (immune complex). Cutaneous ischemic vasculopathy (rabies vaccine) at injection site or elsewhere, immune mediated disease affecting various organs (kidneys and joints). Weeks and months after vaccine was given.
      
      4. Type 4 (delayed type hypersensitivity). Not clearly described in relation to vaccines. Usually with decreased cellular immunity and release of pro-inflammatory cytokines. More than 12 hours after inciting event.

Question 2

What are the inflammatory or neoplastic in nature reactions of vaccines?

Answer 2

• Transient non-specific systemic signs: lethargy, anorexia, fever, generalized soreness, shifting lameness, regional lymphadenopathy.
  
  • Transient injection site reactions: palpable or visible lumps caused by local inflammation/swelling, abscess or granuloma. Pain on site, pruritus (itchiness)
  • Sustained injection site reactions - Hair loss, discolouration of skin, necrosis of skin, granuloma.
• Tumorigenesis: malignant transformation of mesenchymal cells in susceptible individuals.

Question 3

What is FISS?

Answer 3

• Feline injection site sarcoma
  ○ Vaccine site sarcoma, vaccine associated fibrosarcoma, vaccina associated sarcoma.
  ○ Almost exclusively in cats. Very rare in dogs.
  ○ Many tumor types identified; fibrosarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma.
  ○ Possible with any vaccination or injection. Historically associated with FeLV and Rabies.
  ○ Chronic inflammatory reactions are considered the trigger for subsequent malignant transformation

Question 4

What are the vaccine recommended sites in cats?
What should you record?
Where should you avoid?

Answer 4

• Avoid interscapular region area
  
  • Decreasing vaccine volume at time of vax is NOT protective
  • Distal limb and distal tail recommended to facilitate amputation with 5cm margin in 2 facial planes.
  • Record what route the vaccine was given (SC vs IM vs IN vs PO (buccal))
  • Record where each type of vaccine was given
  • Look to see where the previous/months vaccines was given - were there any problems in that previous site, assess the previous area.
    Avoid ventral abdominal SC injection. Still need aggressive tissue removal.

Question 5

What are the vaccine sites in dogs?

Answer 5

• Avoid inter scapular area - other areas of the body are just as easily accessible/usable
  
  • Record where on the body vaccines were given and be specific
  • Record route
  • Look and see previous months/years vaccine site - note any problems
  • Option of SC vs IM - go SC
    Ask your client if they notice any problems with last years vaccine

Question 6

What is the best practice for handling and storing of vaccines ?

Answer 6

• Must always refer to manufacturer specifications
  
  • Must be kept in a temperature-controlled environment from the time they leave the manufacturer to the time they are administered - known as the vaccine cold chain
  • Refrigerated at 2-8 degrees C
  • Placed centrally in the refrigerator to allow for proper air flow.
  • Keep in original packaging/boxes with lids closed until ready to use
  • Single dose/use vaccine (freeze dried and liquid forms) should not be removed from fridge until time of administration
  • New sterile syringe used every time
  • A delay in reconstituting and administration of vaccine could result in decrease of vaccine efficacy
  • Multidose vaccines have preservatives to allow for prolonged storage once seal has been broken
    Always use a diluent provided by manufacture and not a replacement.

Question 7

What do you need to put in the medical record?

Answer 7

• At a minimum a vaccine record should consist of: anatomical location of vaccine administration, age at which vaccine was given, frequency of administration (1, 2, 3 in series)
  
  • Consider also: brand, what the vaccine covers, type of vaccine
  • Vaccine certificate
    Vet team - consistency in recording information for all clients, at all times.