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June 17, 2016

貓疫苗: 我們必須停止過度注射疫苗 (下)

Vaccines for Cats: We Need to Stop Overvaccinating

貓疫苗: 我們必須停止過度注射疫苗

Lisa A. Pierson, DVM
 
作者: 獸醫 Lisa A. Pierson, DVM
 
原文出處連結: http://www。catinfo。org/?link=vaccines
 
(譯註: 中英對照翻譯,沒有翻譯的部份是因為無關疫苗)
Decision-Making Criteria
做決定的依據

(Some of this dialog is also stated in the above sections.)
What are some of the factors that influence our decisions regarding which vaccines to use and at what frequency?

當我們在考量使用何種疫苗以及頻率時,影響我們決定的因素是什麼?

I will say at the outset of this discussion that my indoor-only cats (age range is 13-18 years) have not been vaccinated since they were 4-6 months of age.  They have never set their paws outside and never will - barring a catastrophic event.

首先我要說我的室內貓(年紀介於13-18之間)在他們四到六個月大之後,就沒有再打過任何疫苗了.他們現在沒有,而且以後也不會,跨出家門,所以可防範不好的事件發生.

My barn cat (17 years of age) received his last FVRCP vaccine at the age of 5 or 6 months and received a FeLV series at around 6 months of age (before we knew how dangerous adjuvants can be; PureVax was not around at that time), and is vaccinated with PureVax rabies vaccine approximately every 3-4 years.

我的穀倉貓(十七歲)最後一次打三合一疫苗時是五到六個月大,六個月大時打了白血病疫苗(當時我們還不知道含佐劑疫苗的風險;PureVax也還沒有上市),現在是每三到四年打一次PureVax的狂犬病疫苗.

譯註:不知道皮爾森的穀倉貓是不是真的住在穀倉,但可以確定的是養在室外的貓,
也許是工作貓之類的.

Please note that I do not administer more FVRCP vaccines to my barn cat than I do to my indoor-only cats.  This is because the panleukopenia immunity from the FVRCP vaccine lasts for life in the vast majority of cats and I do not feel that the minimal amount of protection the herpes and calici fraction may provide is worth the downsides of the vaccine.  Remember, it is all about risk-benefit analysis and a person's individual comfort zone. 

請注意,和我的室內貓比起來,我的穀倉貓並沒有打比較多的三合一疫苗.這是因為三合一疫苗中的貓瘟疫苗效期,在多數貓身上是終生的;而且和疫苗的缺點比起來,我不認為只有基本預防作用的貓鼻支氣管炎和卡利西體疫苗有施打的價值。記住,這全都是跟風險有關的考量,以及個人認為妥善舒服的作法。

Now, having confessed my cats' minimal vaccine history, I will state that what is 'right' for me and my cats, may not be 'right' for you and your cat(s).

說出我的貓的預防針歷史後,我要強調的是,那是我個人覺得對我和我的貓"正確"的做法,對你和你的貓而言未必也是"正確"的.

Issues to consider: 考量因素
  • age of patient 貓的年紀
  • risk of exposure to the disease in question 曝露於預防針所預防的疾病的風險
  • prevalence of the disease in the environment 環境中預防針所預防的疾病的普及率
  • consequence of the infection 發炎的後果
  • overall health of the patient 貓的整體健康狀況
  • vaccine efficacy疫苗的效果
  • DOI studies (Duration of Immunity) for the vaccine疫苗免疫期的研究
  • vaccine properties (adjuvanted/non-adjuvanted, etc.)疫苗種類(有無佐劑等)
  • titer testing測驗力價
  • owner's comfort level 主人認為妥善舒服的做法
Let's start with the last one - the owner's comfort level

現在來談談最後一項,主人認為妥善舒服的作法.

This certainly does not sound like a very scientific factor but it is an important issue to consider.  Given the fact that all foreign substances do have side effects when introduced into any living being, I would be a hypocrite if I did not mention the owner's feelings since my own comfort level is tested anytime I decide to inject anything into the body of my own cats or that of my patients.

這當然聽起來不是一個很科學的因素,不過是一個重要的考量因素.所有的外來物被帶入體內時,都會有副作用,這是一個事實,所以如果不提到主人的感覺,我會覺得自己是個偽君子,因為每次在我的貓或是貓病患身上注射任何針劑時,我自己內心都有許多掙扎.

Now having said that, we can't throw the baby out with the bathwater and not vaccinate at all otherwise, our cats (and possibly their humans in the case of rabies) may suffer for it.

我們不能因噎廢食完全不打疫苗,而讓貓被感染.(如果是狂犬病的話,可能主人也會得到)

Now, for the science: 現在,就科學觀點而言:
  • Age of the patient:  Maternally-acquired immunity is an important concept to understand.  When a kitten nurses from his mother, the first milk that she produces (colostrum) is rich with antibodies to fight the various diseases that the mother has been exposed to either naturally from her environment or from any vaccines that she has received prior to giving birth.
注射者年紀:母體免疫力是一個必須了解的重要概念。當母貓給小貓哺乳時,母貓的初乳含有豐富的抗體,可以對抗母貓所處自然環境的疾病,或是母貓生小貓前接種過的疫苗所預防的疾病。

(Hopefully all owned cats have been spayed/neutered so as not to contribute to the tremendous overpopulation problem in this world.  Therefore, most cats that have given birth are unowned or wild (feral) cats that have not been vaccinated and only carry antibodies to diseases present in their own environment.)

(希望所有的家貓都有結紮,不要讓已經過多的貓數量增加。大部份生過小貓而且沒有主人、沒有打過疫苗的貓,身上只有可以對抗環境中的疾病的抗體.)

Maternal antibodies acquired by the kitten inhibit his ability to fully respond to a vaccine.  These antibodies diminish over time and by 16 weeks of age, are at a low enough level in nearly all kittens to allow their immune system to adequately respond to a vaccine.  (Most kittens can respond to a vaccine by 8 weeks of age but we 'pad' it a bit to cover those kittens with longer-lasting maternal antibodies.)

母體抗體讓小貓無法對疫苗做出完整的反應. 這些抗體會隨著時間而減少,小貓十六週大時抗體降到低點,低到幾乎足以讓所有小貓允許自體免疫系統對疫苗做出適當的反應.(大部份的小貓在八週大時就可以對疫苗做出反應,但是我們把時間拉長一點,因為有些小貓的母體抗體存在的時間比較長.)

Therefore, the last vaccine in the 'kitten series' should be given when the kitten is at least 16 weeks of age.

因此,小貓期所打的最後一劑預防針,應該在小貓至少十六週大時注射.

Current conventional protocol states that you can start to vaccinate kittens as early as 6 weeks of age but it would be a very rare situation that would cause me to start vaccinating a kitten at such a young age. 

目前的傳統準則是,小貓六週大時就可以開始打疫苗,但我個人很少幫這麼小的貓打疫苗.

I find that most kittens that are presented for vaccination are kept indoors and are well-isolated from disease.  If the kitten resides in a protected indoor environment, I feel comfortable starting the vaccine series later than the conventional protocol calls for.  This means that I may not start a kitten's vaccines until he is ~9-10 weeks of age, with the second vaccine given at 16 weeks of age.  

我發現大部份來打疫苗的貓都是室內貓,接觸到疾病的機率很低. 如果小貓住在一個有受到保護的室內環境,我認為沒有必要如傳統的疫苗準則建議的那麼早注射.我可能會等到貓九到十週大時才注射第一劑,十六週大時追打第二劑.
  • Risk of exposure:  Does your cat go outside or is he inside 100% of the time?  If he goes outside, is he likely to come in direct contact with other cats?  Is your neighborhood heavily populated with outdoor cats?  How prevalent is rabies in your area?  Etc....
得病的風險:你的貓可以外出嗎?是百分之百的室內貓嗎?如果他可以外出,有可能和其他貓有直接接觸的機會嗎?你家附近有很多室外貓嗎?你居住的區域狂犬病普及率多高?等等...

Keep in mind that even though my barn cat is outside and technically has a higher risk of exposure, given the duration of immunity of the panleukopenia vaccine, he is not vaccinated with FVRCP any more frequently than my indoor-only cats.

別忘了,我的穀倉貓住在戶外,雖然風險比較高,但是他接打的貓瘟疫苗並沒有多於我的室內貓,因為貓瘟疫苗的免疫期是終生的。
  • Prevalence of the disease:  The most important disease to consider under this heading is rabies; its geographic prevalence varies widely.
疾病普及率:最需要考量疾病普及率的是狂犬病,其普及率因地方不同而有很大的差異.
  • Consequence of the infection:  An infection with herpes or calici is far less serious than an infection with panleukopenia or rabies. Also, keep in mind that the herpes and calici vaccines do not protect the recipient from infection since their efficacy is not as strong as the vaccines for panleukopenia and rabies. Herpes and calici vaccines only lessen the severity of symptoms but will not prevent infection.  This is an important fact as it pertains 屬於to the risk-benefit analysis.  (The risk of sarcoma, kidney inflammation, etc., outweigh the small, if any, benefit of frequent re-vaccination.) 
感染疾病的後果:感染到貓鼻支氣管炎以及卡利西病毒的後果,遠遠不及貓瘟或狂犬病那般嚴重.再者別忘了,貓鼻支氣管炎以及卡利西疫苗無法達到完全不被感染的保護,因為這二種疫苗的效力遠遠比不上貓瘟和狂犬病疫苗。貓鼻支氣管炎和卡利西疫苗只能做到減輕症犬,無法做到完全預防感染。這是風險考量時一個很重要的因素.(頻繁注射疫苗的優點,遠遠小於肉瘤和腎臟發炎的風險)
  • Health of the patient:  Vaccines are to be administered only to healthy patients.
注射者的健康:只有健康的貓才能打疫苗.
  • Previous vaccine reactions:  All past vaccine reactions - no matter how minor - must be taken into consideration when making future vaccine decisions.  Under most circumstances, I will not re-vaccinate a patient that has had an allergic reaction since the next time may bring on a more serious reaction.
以前的疫苗反應:過去注射疫苗的所有反應,不管是多麼微小,都應該被列入考量。只要曾經有過敏反應出現,我就不會再施打疫苗,因為下次注射可能會有更嚴重的過敏反應。
  • Vaccine efficacy:  Vaccines vary in their ability to confer strong immunity within the patient.  Some vaccines, such as the FIV (Feline Immunodeficiency Virus) vaccine are not very effective at stimulating immunity in the recipient.  In addition to this issue, the FIV vaccine is a killed product which means it contains an adjuvant.  Therefore, it should not be administered to any cat, in my strong opinion, due to the risk of VAS.
疫苗效力:疫苗增強免疫系統的能力各有不同.有些疫苗,例如貓愛滋疫苗,在刺激免疫力時效果很差.此外,所有貓愛滋疫苗都含有佐劑,因此所有的貓都不該打貓愛滋疫苗,這是我個人強烈的建議,基於得到肉瘤的風險.

As noted above, Herpes and calici vaccines are also lacking in the ability to induce complete protection.  At best, they will only reduce the severity of some symptoms but will not prevent infection with these viruses and will not protect the recipient from all symptoms of disease.  The risks of repeated vaccination outweigh the benefits in most situations.

先前提過,貓鼻支氣管炎和卡利西病毒疫苗無法做到完全預防的保護,最多只能達到減輕病狀。所以在多數狀況中,重複施打疫苗的風險大於優點.
  • Duration of immunity (DOI):  The duration of immunity (how long a vaccine protects the recipient) varies with each disease/vaccine and, of course, with each patient.  However, one vaccine that we do have strong data for is the panleukopenia vaccine which is a very good thing considering how contagious this fatal disease is.
免疫期:免疫期的長短因疾病、疫苗以及注射者不同而有異。.然而,免疫期數據資料最多的疫苗是貓瘟疫苗,這是一件很好的事,考量到這種致命疾病的高傳染性。

From two different studies, we know that the panleukopenia vaccine confers immunity for at least 7.5 years (the study was stopped at that point) and most immunologists feel that the vaccine lasts for life in the vast majority of cats.  If a cat falls into the rare category of not being protected for life, it is thought that this cat is a 'non-responder' and may fail to respond even if further panleukopenia vaccines were given.

從兩份不同的研究結果,我們知道貓瘟疫苗給予至少七年半的免疫期(這份研究終止於此時),大多數的免疫學家認為,疫苗效期對多數的貓是終生的. 如果一隻貓的免疫期不屬於終生有效型,那有可能是無法對疫苗有反應的貓,即使有追打貓瘟疫苗。

All that said, panleukopenia is a nasty disease and if I had a cat that was going to be exposed to, for example, foster cats and that cat had not been vaccinated for panleukopenia within the previous 8-10 years, I would consider re-vaccinating.  Or, better yet, do not allow the cat to be exposed to other cats of unknown vaccination/infection status.

先前說過貓瘟是可怕的疾病,如果我有一隻貓,即將和中途貓,或是有八到十年沒有打過貓瘟疫苗的貓有接觸,我會考慮再打一次疫苗.更好的做法是,不要讓你的貓跟疫苗歷史不明的貓有接觸的機會.
  • Vaccine properties:  As I have stated many times, I do not use an adjuvanted vaccines.
疫苗屬性:我已經說過很多次,我不使用含佐劑的疫苗.
  • Titers:  Note that titer testing is only done for panleukopenia and rabies (for international shipping) and not for herpes and calici.
力價:請注意,力價測驗僅用於貓瘟和狂犬病(國際運送),不用於貓鼻支氣管炎和卡利西病毒.

Think of the immune system as a 'gun' and antibodies as 'bullets' for the gun.  A titer measures the amount of antibodies for a specific disease that are currently circulating in the blood stream of the body.  This sounds like a great test but the information we get from titer testing is only part of a much bigger picture.

如果免疫系統是一把鎗,那麼抗體就是鎗中的子彈.力價是針對某一特定疾病,測驗有多少抗體目前正在體內運行. 聽起來是很好的測驗,但其實從力價測驗所得到的訊息只是部份而已.

Notice that I emphasized the word "current" in the paragraph above.  This is because of 'memory cells' which are cells in the body that titer testing cannot measure.  Memory cells are primed by a previous natural exposure or vaccination to a pathogen (virus, bacteria, fungus, etc.) and are ready to quickly (within hours) produce more antibodies the moment the body is exposed to the invader again.  These cells do not produce antibodies - and therefore, do not contribute to the titer level - until the body is attacked by the pathogen.

上一段我強調"目前"這兩個字. 這是因為力價無法測出體內有多少"記憶細胞".身體感染過某種疾病,或是針對某種病原(病毒,細菌,真菌等)打過疫苗,體內的細胞還留有記憶且處於待命狀態,所以一旦病毒侵入時,身體會快速(幾個小時內)製造出更多的抗體。身體受到病原攻擊時,這些抗體才會出現,因此不會被計入力價測驗出來的抗體中。

Antibodies are not the only type of 'bullet' that the immune system uses.  There is another type of 'ammunition' called cell mediated immunity (CMI) which is a very important arm of the immune system that, unfortunately, we cannot measure with any commercially available test - including a titer test.

抗體並不是免疫系統所會使用的唯一一種"子彈". 有另一種"彈藥"被稱之為細胞媒介免疫,是免疫系統很重要的武器,很不幸的是目前沒有任何檢驗可以測量細胞媒介免疫,力價測驗也測不出來.

Given the above, it is obvious that titer testing has some severe limitations when being used to assess the status of a patient's immune system.  If a titer is low, that does not necessarily mean that the patient is unprotected.  If he has a lot of memory cells standing by waiting, he is considered to be well-protected against diseases that are best eliminated with a quick antibody response.

從以上的訊息我們可以知道,要判讀病人體內的免疫系統狀態,力價測驗能力有限. 如果力價很低,並不表示測驗者沒有受到保護. 如果測驗者體內有很多記憶細胞在待命,表示身體有受到很好的保護,體內迅速的抗體反應可以消滅入侵的疾病.

So when may titer testing be helpful?

所以什麼時候力價測驗才是有幫助的?

As discussed above, two examples are:

如上面所討論,有以下兩種狀況:
  1. to decide if you want to give the 1-year booster after the last kitten vaccine
小貓期最後一劑預防針施打一年以後,決定要不要再追加一針前,先做力價測驗.
  1. to decide if you want to vaccinate an altered adult cat that came to you with an unknown vaccine history
一隻已結紮的自來貓找你當主人時,先驗力價再決定要不要打預防針.

If an UNaltered stray cat ends up on your doorstep, chances are that he or she has not been vaccinated - and should receive a vaccine now.

如果出現在你家門口的自來貓沒有結紮,有可能沒有打過預防針,此時打預防針是應該的.

Titer interpretation: 解讀力價:
If a cat shows any titer at all, this means that he has either been vaccinated in the past (and responded to that vaccine) or he has been naturally exposed to the disease.

當力價測驗顯示貓體內有病毒抗體時,那表示他可能以前打過預防針(而且對預防針預防的疾病有反應),也有可能他過去曾經曝露在那個疾病的風險中。

According to the World Small Animal Veterinary Association Vaccine Guidelines Group (WSAVA-VGG), a positive test result would lead to the conclusion that revaccination is not required.

世界小動物獸醫協會的疫苗規章指出,力價測驗顯示體內有抗體時,重複施打疫苗是沒有必要的.

Note that a low (versus high) titer does not necessarily mean the cat is unprotected since memory cells and cell mediated immunity are, in all probability, present in full-force.  This is very important to understand because the advent of titer-testing has led to unnecessary revaccination of many patients just because they came up low on their titer test.

請注意:力價測驗結果顯示抗體量是低的時候,並不表示貓的身體沒有受到保護,因為體內還有記憶細胞和細胞媒介免疫提供全面防備. 瞭解到這一點是很重要的,因為力價測驗的出現,導致很多貓接受不必要的重複施打預防針,只因為測驗結果抗體是低的.

A negative titer means that the cat may, or may not be, protected.  The WSAVA-VGG recommends vaccinating these cats while acknowledging that these patients may be fully protected and not need to be vaccinated.  They are, understandably, taking a 'better safe than sorry' approach since panleukopenia is such a serious disease.

一個陰性的力價測驗結果(即沒有抗體),表示貓可能有,也可能沒有受到保護. 針對這種狀況,世界小動物獸醫協會的疫苗規章建議施打預防針,即使這些貓可能其實身體有抗體保護,不需要打預防針。但基於安全考量,還是建議施打,避免遺憾,因為貓瘟是一個很可怕的疾病。

If a cat with a negative titer is subsequently vaccinated (with a properly manufactured and handled vaccine) and has his titer re-checked with another negative result, this patient would fall into the 'non-responder' category and should not be vaccinated again.

如果力價測驗是陰性反應而打了預防針(妥善製造和處理的疫苗),之後再次做力價測驗時結果依然是陰性,那表示這隻貓無法對疫苗做出反應,以後不應該再施打疫苗。

Conclusion 結論
I wish that I could tell you that there are a straight-forward, clear-cut answers for all decisions involving the vaccination of our cats but there are simply too many variables involved to make this a reality.

在決定要不要幫貓打預防針時,我真希望可以給你一個簡單明瞭的答案,但現實環境中要考量的因素實在太多.

As noted above, please understand that I cannot offer any advice via email.  If you wish to discuss your personal situation, I am available for phone consultations as noted at the bottom of this web page.
In closing, I would like to see less money being spent on over-vaccination of our cats and more money being spent on dental health care which will be the subject of my next webpage.

我的結論是,我想要看到比較少的錢花在過度施打疫苗上,把比較多的錢花在貓的口腔健康照顧上.

Preview:  Please consider brushing your cat's teeth since it is the very best way to maintain their dental health.
And please do not subject your cat to anesthesia-free dental cleanings which provide very little benefit since the problems are under the gum line and these 'awake' cleanings only serve to stress your cat and your pocketbook for very little, if any, benefit.
(No cat is going to let a human probe and clean under their gum line.)
These anesthetic-free cleanings simply result in is a false sense of security leading the cat owner to believe that they have adequately addressed their cat's dental needs.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Supporting research regarding vaccinations - 2 abstracts:
關於疫苗的研究 - 摘要兩則

I put some text in bold.  Please note that Dr. Ron Schultz is one of the leading experts in immunology and is highly respected.

有些內文我用粗體字。舒爾茲獸醫(Dr. Ron Schultz)是免疫學的領導專家之一,而且備受尊重。 狗貓的年紀以及長期免疫力
J Comp Pathol. January 2010;142S1(0):S102-S108.
R D Schultz1, B Thiel, E Mukhtar, P Sharp, L J Larson
1 Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.

譯註:上面這段的第一行指出原文出處.J Comp Pathol 是一個醫學期刊,全名是 Journal of Comparative Pathology.至於 January 2010表示是2010年一月出版.

Abstract: 摘要
Vaccination can provide an immune response that is similar in duration to that following a natural infection. In general, adaptive immunity to viruses develops earliest and is highly effective. Such anti-viral immune responses often result in the development of *sterile immunity and the duration of immunity (DOI) is often lifelong.

疫苗所提供的免疫力,和得過病而具備的免疫力,兩者是類似的. 基本上,最早出現的是針對病毒的後天免疫力(或稱適應免疫力),而且極有效率. 如此的抗病毒免疫反應,其結果帶來的是全面免疫力,而且免疫期往往是終生持續.

In contrast, adaptive immunity to bacteria, fungi or parasites develops more slowly and the DOI is generally short compared with most systemic viral infections. Sterile immunity to these infectious agents is less commonly engendered.

相反的,針對細菌、真菌或寄生蟲的後天免疫力出現的比較慢,而且和多數的病毒感染比較起來免疫期比較短.這些感染原的全面免疫力是普遍比較不會出現的.

*Dr Pierson's comment:  "Sterile immunity" refers to the immune system preventing infection with the offending agent.  "Non-sterile immunity" refers to the fact that the pathogen can still infect the body (herpes and calici, for instance) but the clinical signs will not be as severe in a vaccinated animal when compared to an unvaccinated animal.  End comment.

* 本文作者皮爾森醫生的說明:[全面免疫力]指的是當感染原攻擊身體時,免疫系統會保護身體預防感染。[非全面免疫力]指的是身體依然會受到病原感染(例如貓鼻氣管炎和卡利西),但是有打疫苗的動物,臨床症狀不會和沒有打疫苗的動物一樣嚴重。說明結束。

Old dogs and cats rarely die from vaccine-preventable infectious disease, especially when they have been vaccinated and immunized as young adults (i.e. between 16 weeks and 1 year of age). However, young animals do die, often because vaccines were either not given or not given at an appropriate age (e.g. too early in life in the presence of maternally derived antibody [MDA]).

老貓和老狗很少死於疫苗所預防的疾病,尤其是當貓狗年紀小時(介於十六週到一歲之間)就已經注射過疫苗.然而,年紀小的動物的確會死亡,原因往往是因為沒有在適當年紀接種疫苗(例如太早施打疫苗,體內還有母體抗體).

More animals need to be vaccinated to increase herd (population) immunity. The present study examines the DOI for core viral vaccines in dogs that had not been revaccinated for as long as 9 years. These animals had serum antibody to canine distemper virus (CDV), canine parvovirus type 2 (CPV-2) and canine adenovirus type-1 (CAV-1) at levels considered protective and when challenged with these viruses, the dogs resisted infection and/or disease.

更多動物需要施打疫苗以提高群體免疫力。目前有一項研究,對象是最長九年沒有重覆打核心疫苗的狗這些狗體內有犬瘟熱、犬二型小病毒、犬一型腸病毒的抗體,而且血清中的抗體含量被認為足以提供保護,當身體受到這些病毒的攻擊時。

Thus, even a single dose of modified live virus (MLV) canine core vaccines (against CDV, cav-2 and cpv-2) or MLV feline core vaccines (against feline parvovirus [FPV], feline calici virus [FCV] and feline herpes virus [FHV]), when administered at 16 weeks or older, could provide long-term immunity in a very high percentage of animals, while also increasing herd immunity.

因此,即使只施打一劑犬核心減毒疫苗(預防犬瘟熱犬二型小病毒犬一型腸病毒)或是貓核心減毒疫苗(預防貓瘟卡利西病毒、貓鼻氣管病毒)而且是在年齡十六週以上才施打,可以在很高比例的動物身上提供長期免疫力,同時也提高群體免疫力.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 一隻可卡幼犬因為過度注射疫苗而可能引起的膜增生性腎小球腎炎

Ortloff A, Moran G, Olavarria A, Folch H. J SMALL ANIM PRACT 51:499-502, 2010.

This report described a clinical case of membranoproliferative glomerulonephritis (MPGN) in a young dog. The 7-month-old male cocker spaniel presented to the veterinary clinic with vomiting, diarrhea, lethargy, and anorexia. The puppy had been previously healthy with no prior disease, drug treatment, or toxin exposure. However, the puppy had been vaccinated by the owner (without veterinary direction) a total of 7 times (once per month) with a distemper/hepatitis/leptospirosis/ parainfluenza/parvovirus (DHLPP) vaccine.

這份報告描述的是一隻小狗的膜增生性腎小球腎炎. 七個月大的可卡公犬被帶到醫院時,症狀有嘔吐、腹瀉、沒有精神以及厭食. 之前健康狀況良好,沒有任何病史和用藥歷史,也沒有曝露在有毒的環境中. 但是小狗被主人(在沒有獸醫的指導下)施打了七次五合一疫苗,一個月一劑.

The puppy was severely dehydrated on clinical presentation and demonstrated pale mucous membranes, oral ulcerations, halitosis, and abdominal pain. Several diagnostic procedures were performed, and ultrasonography revealed loss of renal architecture, increased cortical echogenicity, and bilaterally decreased kidney size.

小狗嚴重脫水,黏膜泛白、口腔潰瘍、口臭以及腹痛. 好幾個診斷被進行,超音波顯示腎臟基本結構喪失高皮質回音,雙側腎臟縮小.

Complete blood count and serum biochemical values were consistent with renal disease, including anemia, severe azotemia, hyperphosphatemia, and hypoalbuminemia. Urine culture was negative. The puppy was aggressively treated for renal failure, including peritoneal dialysis, but died 3 days after hospital admission.

血液和血清生化檢查確定病狀符合腎臟病,包括貧血、嚴重氮血症、高磷血症以及低白蛋白血症.尿液培養呈陰性反應. 積極治療腎衰竭,包括腹膜透析,但小狗在入院三天後死亡.

Necropsy was authorized, and revealed ascites, retroperitoneal and abdominal edema, small pale kidneys, and kidney morphologic changes consistent with glomerulonephritis. Electron microscopy and immunehistochemical testing demonstrated the presence of deposits in the glomerular subendothelial spaces and the basal membrane; this was consistent with antigenantibody immune complexes.

屍體解剖顯示有腹水、腹膜後和腹部浮腫、小而且泛白的腎臟以及腎型態改變,符合腎小球腎炎的症狀。電子顯微鏡和免疫組織化學測驗,顯示腎小球內皮下以及基底膜有沈積物;症狀符合抗原抗體免疫複合物.

In addition, antigens in the complexes were similar to the vaccine antigens in the DHLPP vaccine, suggesting that the glomerulonephropathy in this puppy was secondary to frequent and unnecessary vaccination.

此外,複合物中的抗原,和五合一疫苗的抗原類似,顯示小狗的腎小球腎炎是過度頻繁且多餘的注射疫苗所引起.

Commentary: Although membranoproliferative glomerulonephritis is reported as 1 of the most common glomerulopathies in dogs, a definitive diagnosis and identification of the offending antigen are rarely identified due to the risk and expense associated with renal biopsies and electron microscopy.

結論:雖然膜增生性腎小球腎炎是狗最常見的腎小球腎炎之一,但明確的診斷以及病原辨別很少被執行,因為採取活體腎臟組織檢驗以及電子顯微鏡風險高,而且所費不貲.

This case report demonstrates that injudicious use of vaccinations may, like other infectious or autoimmune diseases, lead to immune complex deposition and subsequent glomerular damage.

從這份病歷報告可以看出,不明智的使用疫苗,和其他感染或自體免疫疾病一樣,可能會導致免疫複合物的沈積,進而破壞腎小球.

When possible, appropriate education should be provided regarding the rationale for current vaccine guidelines to avoid overvaccination.

為了避免過度施打疫苗,應該要適當的教育目前的疫苗基礎準則.

Further studies are required at this time to determine the role if any that recent past and current vaccine protocols play in the development of protein-losing nephropathies. Shawn Kearns, DVM, Diplomate ACVIM

獸醫 Shawn Kearns, DVM, Diplomate: 在此同時也出現進一步研究的必要,以決定最近的過去以及目前的疫苗準則,在造成蛋白質流失的腎病發展上,所扮演的角色。

Important update:  As is evident by my website, cats are my passion and my goal is to help as many as I can before I depart this earth.  To this end, I have spent a tremendous amount of time over the past 12 years reading and responding to thousands of emails that have been sent to me asking for help/advice and "further explanation" of information on my website. 
 
Unfortunately, this has resulted in a significant sacrifice of my personal time and I have reached a point where I can no longer read or respond to the large volume of emails that I receive.
 
On a very good note, the emails make me smile because I know that the message is being heard and more cats are receiving better nutrition and care.
 
On the other hand, the large volume of people asking for my time has become overwhelming.  Therefore, this statement will appear throughout this site as well as the bottom of every page:
 
No individual advice or further explanation for any reason will be provided via email.
 
That said, if you desire personalized help and would like information regarding my phone/Skype consulting service, please send your request to DrPierson (at) catinfo.org.  Make sure that you put "Consultation Service" in the subject line which may help prevent your request from ending up in my spam folder and increase your chance of hearing back from me.
 
April 2011
Partially updated October 2014
Lisa A. Pierson DVM
DrPierson@catinfo.org
 
本文發表於二零一一年四月
部份更新於二零一四年十月
 
本文作者獸醫麗莎皮爾森(Lisa Pierson, DVM) 於一九八四年畢業於加州大學戴維斯分校獸醫系(the University of California, Davis School of Veterinary Medicine)。目前執業以提供線上電話(skype)收費諮詢為主,包括提供病貓專用食譜。如果你想要進行諮詢,請寄電郵至 DrPierson@catinfo.org, 主旨標明 “consultation service”。(諮詢當然是以英文進行,每小時費用好像是美金二百五十到三百元之間,如果我沒記錯的話。想諮詢的人自己去跟皮爾森砍鳳,乖。. )
 
 


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