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The Daily Vet by petMD

The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets.

Molly’s Bill Exempts Some Dogs from Rabies Vaccination

I feel compelled to praise the California government for making vaccination an individual decision undertaken as a collaboration between pet owners and veterinarians. This is a victory for our canine companions, as circumstances exist where a vaccination can induce illness and can be a contributing cause of death.

Until Molly’s Bill (AB 258) was signed into law on October 7, 2011, Calif. Health and Safety Code, Sec. 1920 and [Los Angeles] County Code Title 10, Sec. 10.20.220 stated, "Rabies vaccinations are required for all dogs 4 months of age or older. Failure to comply may result in a citation and a court appearance. Vaccinations must be valid for the entire licensing period."

AB 258 will "exempt from the vaccination requirement a dog whose life would be endangered due to disease or other considerations that a veterinarian can verify and document if the dog received the vaccine, as determined by a licensed veterinarian on an annual basis. The bill would also require a dog that is exempt from the vaccination requirement to be confined to the premises of the owner, keeper, or harborer, and would require, if the dog is off the premises of the owner, keeper, or harborer, the dog to be on a leash not to exceed 6 feet in length and to be under the direct physical control of an adult."

Here’s some background on vaccination requirements for California pets. Rabies is the only legally required vaccination for dogs, while cats have no vaccination requirements.

So, who is Molly and what are her health concerns meriting exemption from rabies vaccination? Susan Thixton from the Truth About Pet Food reports:

"Molly is a Springer Spaniel who contracted an autoimmune disease which kills her own red blood cells. Molly contracted this disease after receiving her yearly Rabies vaccine. Understandably so, Molly's owners refuse to revaccinate Molly believing another vaccine would kill her; their veterinarian agrees. However, because California law does not allow for a rabies exemption for sick dogs and cats, Sam and Cecilia Gadd of Chino Hills, CA (Molly's folks) remain in violation of the law and Molly remains in quarantine [under house arrest]."

At the time of Thixton’s quote, AB 258 had not yet been approved.

Both Molly and my dog Cardiff have Immune Mediated Hemolytic Anemia (IMHA). The term immune mediated is more appropriate than autoimmune, as it’s an updated and more specific classification of immune system abnormalities. Immune mediated conditions can be primary or secondary. A primary disease is inherent to one’s genetics and can truly be considered autoimmune. A secondary disease is caused by a stimulus (cancer, infection, toxic or environmental exposure, vaccination, etc.).

Other immune mediated diseases include Immune Mediated Thrombocytopenia (IMTP, where blood-clotting platelets are destroyed) and Pemphigous Folieaceous (a painful form of chronic skin inflammation). Regardless of primary vs. secondary status, unnecessary immune system stimulation should be avoided for pets having these conditions.

AB 258 was up for consideration by legislative assembly in 2010, but it was not approved. California Assemblyman Curt Hagman reintroduced it for the 2011 assembly based on the efforts of the Gadd family and Western University of Health Sciences student Lisa Lippman (who is also my client).

Like the Gadds (and myself), Lippman is personally connected to AB 258‘s cause. Lippman’s beloved and now deceased dog Max suffered from Pemphigus Folieaceous and couldn’t be licensed when she moved to California to attend veterinary school. Max’s rabies vaccination was administered at a time when it was legally necessary for him to receive a booster to satisfy licensing requirements. "A vaccine would stimulate an immune system that has already gone out of control," said Lippman. "[Max] was already protected from all the previous rabies vaccines I've given him over the years. It's a sad situation. I don't want to potentially risk my dog's life for a vaccine for a disease he's already protected from."

"Rabies is a serious and lethal health threat," she added. "This (AB 258) doesn't change the law, it just provides an exemption for veterinarians to do their job."

I agree wholeheartedly with Lippman, as AB 258 promotes the best health of our pets as an individual decision between the pet caretaker and veterinarian instead of a blanket rule mandated by the state of California. Pets that have previously had an adverse response to vaccines are additional examples of when an alternative to vaccination administration should be considered.

As Cardiff’s veterinarian, I closely observe his ability to respond to rabies by performing blood tests (antibody titers) for rabies (along with distemper and parvo) at least every 12 months. Cardiff’s rabies titers have always been adequate despite not having been vaccinated since 2008 — well before his first of three IMHA episodes.

I find comfort in California’s recognition of my status as the primary decision maker regarding Cardiff’s immune system health and vaccination status.

Cardiff suffers from a post-transfusion reaction by acting lethargic and lying in an unusual location during one of his IMHA episodes.

Dr. Patrick Mahaney

Image: Cardiff on transfusion day, by Patrick Mahaney

Comments  25

Leave Comment
  • Exemption
    09/25/2012 07:18am

    Definitely a step in the right direction. Hopefully this will not be an excuse for people not to vaccinate without having the proper reasons (and documentation).

    Regarding the picture of Cardiff after a transfusion, perhaps sometime you could talk about transfusions for critters, when they might help, why they might help, the animal's reaction and any statistics on outcomes.

  • 09/27/2012 01:28am

    Great comments.
    I definitely hope that people still keep in mind that we should vaccinate our pets (dogs, cats, and other species) against fatal illness such as rabies.
    The majority of the pets that receive rabies vaccination do not show an adverse response. Pets that are sick or have emerging clinical illness are more prone to adverse vaccination reactions (such is why I suggest preventing illness from happening in the first place, even preventing periodontic disease and obesity).
    Thank you for the suggestion about transfusion reactions. It's deathly goes on the list for future writing topics.
    Dr PM

  • Vaccines
    09/25/2012 03:39pm

    "A vaccine would stimulate an immune system that has already gone out of control," said Lippman. "[Max] was already protected from all the previous rabies vaccines I've given him over the years."
    I've two male neutered indoor cats, 11 and 10yrs of age, that haven't gotten their 'shots' in a few years due to health issues. The older one especially with his full mouth extraction from severe stomatitis, and immune issues. The younger with alot of anxiety and bowel issues. Recently the vet suggested I at least give them a rabies shot by law in my state once a year. Lots of rabies cases lately, but I declined. As other cats I've had got older and mostly had health issues, I stopped all shots for them. Any further comments, guidance? Would I have to get a titer to see their level of protection or could we continue to decline shots for their life duration? The combo shot is every two years - I think the only issue here might be a rabies shot. Thanks.

  • 09/27/2012 01:33am

    Think you for your comments and questions.
    I would determine the legal requirements for vaccinations for cats in your state and then create a plan from there.
    Will you suffer any legal consequences if you don't follow the exact guidelines as mandated by your state? Such is a question I cannot answer for you.
    I would pursue at least blood titers for rabies, which will reveal your cats current level of immunity against the virus. Normal levels do not mean that your pets has absolutely no chance of developing the disease if exposed (as immunity is a complex process), but it indicates that there will likely be a response that will deter infection.
    I hope to see you back again on my The Daily Vet page.
    Dr PM
    www.PatrickMahaney.com
    Twitter @PatrickMahaney

  • 09/27/2012 08:15am

    Thanks for all your replies here Doctor! I will commiserate with the vet. More cat topics please!

  • Different Laws
    09/25/2012 05:16pm

    How lucky we are to live north of the 49th parallel. Here we aren't required to provide vaccine information to purchase municipal pet licenses.

    We also just did titers and found, like you, Dr. Mahoney, that the results were still just fine for a number of years. We had an FIV+ cat that might have been at risk, so I was relieved we could do this as he was in poor shape when we took him in after a heavy bout of vaccines when his former owner had adopted him.

    When we moved, the best veterinarian we could find didn't agree with me on the vaccine issue and insisted the FIV+ cat also be given boosters. Luckily, not only did the cat manage fine by that point, several years later, but also we had our own incident where he chased a bat in from our deck one night. I was glad not to have to worry about the cat while getting the bat to leave and worrying about my own safety.

    I agree with you that it is good for us to have the alternatives there, but have to agree with our new veterinarian that if the pets are doing well after life threatening disease vaccines are given, it is better to be safe, based upon personal experience.

  • 09/27/2012 01:38am

    Thank you for your comments.
    I actually agree with you on the benefits of vaccination.
    If you have a pet that already has an immunocompromising disease, such as Feline Immunodeficiency Virus (FIV), and has now been given vaccinations to get things "up to date", I would consider pursuing antibody titers in the future. Just because an expiration date passes or a legally mandated requirement for a specific vaccination booster comes up does not mean that administering the immunization is the healthiest choice for your pet. With an FIV positive cat, I would especially focus on maintaining oral cavity health and promoting immune system health through whole food based cooked nutrition and immune system supporting nutraceuticals.
    Dr PM

  • 09/27/2012 01:24pm

    Our FIV+ boy had the healthiest teeth and gums you could ask for in a cat. We think that this may have contributed to his acquisition of FIV in the first place. I am commenting here, because I think that the different clades of FIV sometimes have differing characteristics as he also had to be segregated for the whole of his lifetime with us to protect our other charges.

    He is still sorely missed as he died of a heart attack earlier this year when he refused to eat while mourning the dog who had been the only animal contact he was allowed.

    We were basing our choices on the fact that he didn't show any outward signs of reaction to the three year boosters he was getting for rabies. We are also on the West Coast so have to worry about those same bats that give you concern.

  • Maybe not so necessary
    09/25/2012 06:04pm

    The United States has been canine strain rabies free since the 70's. We shouldn't be required to vaccinate for a disease that no longer exists. It's just like smallpox. I had a smallpox vaccination when I was a kid, but they quit giving those to kids a long time ago.

    Some areas have a lot of raccoons that have raccoon strain rabies and some have a lot of bats that also carry bat strain rabies. It might be advisable to vaccinate in those areas, but it certainly should NOT BE A CRIME TO NOT VACCINATE. That is just silly....and/or over bullying by government.

    Should there happen to be a full blown outbreak in an area there isn't any reason why people could not vaccinate at that time. Same as they have been doing with polio for quite some time.

    Our government just wants to maintain this "requirement" of dog owners.

  • 09/27/2012 01:42am

    Interesting perspective.
    Certainly as disease patterns change, the government mandates should also change to best observe the over all health of our pets.
    I believe that's providing rabies vaccinations during puppy, kitten, and young adult years, then doing antibody tighter testing to determine levels is hey smart holistic health strategy to determine if a rabies vaccination booster is even needed.
    Yes, not everybody has the funds or is willing to pay for a blood test. It would be great if there was some sort of government subsidy that would help to make up the cost to owners that want to abide by government guidelines and actually determine their pets immunity towards a vaccination that's a state dictates a pet must have.
    I hope to see you back again on my The Daily Vet page.
    Dr PM
    www.PatrickMahaney.com
    Twitter @PatrickMahaney

  • 09/27/2012 08:28am

    There is way too much fuss over this extinct disease. Law enforcement acts like it is a life or death situation. It isn't. The chances of dying from contaminated food is greater than coming into contact with rabies.

    I realize this rabies vaccine mandate is the bread and butter for most veterinarians. The vaccine is available for as little as $1.50 per dose, while vets charge $10-$50 to administer. I know, they say "with a check up", etc. Michigan requires the vaccine be given by a veterinarian. That isn't needed. They have subq vaccines now. Those are easy for anyone to give. But no, we are required, by law, to go the expensive route to protect against an extinct disease. I have severe misgivings about any vet giving any advice on this subject. They just have too much personal gain to be realistic.

    Nice blog, but Dr. PM -----------please, please have someone edit your posts and responses. They are difficult to read with incorrect punctuation and spelling. C'mon......it looks bad when a vet spells titer as "tighter". Makes a person wonder if he knows what titer is. I know, I know...doctors are famous for horrid handwriting and I suppose punctuation and spelling is included in that. But this looks bad online. I'm not trying to be mean or anything like that.

  • 09/27/2012 11:01am

    I don't really feel as though one can consider rabies to be a dead disease considering that over 50,000 people are infected by the disease on a worldwide basis each year according to Los Angeles County public health reports.
    http://publichealth.lacounty.gov/vet/rabiesmanual/introduction.htm
    In fact, A record-high of 45 rabid bats have been confirmed in Los Angeles County this year. Although the chance of getting bit by one of these bats is relatively low, the potential does exist.
    I will keep a closer eye on my spelling and grammar in my replies to my reader's comments. I often use a voice recognition system and need to better check to see if it thinks I'm saying "tighter" versus "titer".
    Additionally, I will pass on your comments about grammar and spelling to my editors who evaluate my articles before they are published.
    Thank you,
    Dr PM

  • 09/27/2012 05:29pm

    Those 50,000 cases of rabies are in foreign countries.
    Canine strain has been gone from the U.S. since the 70's......that's over 40 years. To continue vaccinating every dog is just way too much overkill.

    The CDC has extensive reports available online.

    I'm thinking there are probably more people struck by lightning each year, than bit by a rabid bat. I've not compared any statistics, but cases of rabies are quite rare. The more recent ones have been from dogs imported and from transplant from an infected donor ( I think bitten in a foreign country ).

    Still, we spend billions vaccinating. Overkill.

  • 09/27/2012 06:07pm

    I should mention that if we ever have our cats housed in facilities, veterinary or otherwise, our hope is that the other animals there have been protected from transmittable diseases, as, with veterinary housing in particular, our own pets are usually more vulnerable during those periods.

    While I don't ever want to see feral cats not being cared for on the streets, I also wish owners would consider just how much maintenance of their pets is going to cost before adopting. Far too many pets don't get the healthcare they need, and of course, when they do end up at the veterinarians' offices, they aren't properly protected from these transmittable diseases that worry me.

    I like the fact that we have options where we live, and at the same time wish that budgeting courses were manditory for pet owners who can't cope financially when pets need it most.

    JMHO.

  • Vaccines
    09/26/2012 08:02am

    From the age of two I titer tested my dog yearly and never had to give her a vaccine except for rabies. When she was ten she was due for rabies, but her kidney values were elevated and my vet advised against the vaccine. I live in MI and it is required by law, so we did a titer test and she was protect. I long for the day when titers will be accepted for rabies, instead of just doing what is required by law. Way to California!

  • 09/27/2012 01:46am

    Thank you for sharing your Michigan based experience on rabies vaccination, titers, and overall pet health.
    As a California transplant who hopes it will be my forever home, I have to believe that most good things start in California and then move elsewhere.
    Hopefully, your states' government will be able to use Molly's bill as an example of a positive means that permit vets to best oversee the individual health of a patient as pertains to rabies vaccination.
    I hope to see you back again on my The Daily Vet page.
    Dr PM
    www.PatrickMahaney.com
    Twitter @PatrickMahaney

  • 09/27/2012 05:32pm

    MI does not allow for any exceptions to the rabies requirement. If they didn't vaccinate their dog, they are in violation of the state law.

  • Rabies in bats
    09/27/2012 01:54pm

    I live in a somewhat rural area in California. I own a small feed store and there was a colony of bats living behind a sign for another business that shares the building in which my business is located. Every evening, they would come swooping out all around and over my hay storage areas. One day, my dog and I found one flopping around on the ground when we opened up in the morning. I immediately called animal control; they picked it up to test and I called my vet. My sheltie was about two-years-old and current on his vaccination but we decided to give him a booster for rabies just to be safe. I did not think he touched the bat but it was worrisome.
    In the meantime, the bat tested positive for rabies, which meant I most likely had a whole colony of rabid bats living at my business. I told everyone I would not load hay or allow anyone else to do so in the evenings when the bats imerged.
    We have raccoons and other wildlife around here and we have many dog owners who do not keep track of their pets. They wander and get into all sorts of stuff...tangle with skunks, racoons and who knows if they might meet up with a bat! With so many irresponsible owners, I am glad a rabies vaccination is mandatory. If it were optional, there are many people who would not bother. I do agree that if the vaccine might cause serious harm to a particular dog, that dog should be exempt. I was exempt from having a measles booster in college becuase I have an allergy to one of the components of the vaccine. Otherwise proof of immunization is probably a good idea. If, throught titer testing, one can show continued immunity, that should be fine, too. But, until people are more responsible, it is important to keep up with vaccinations for a disease that a death sentence.

  • 09/27/2012 05:36pm

    Not likley the whole colony was infected. They would all be dead! Rabies doesn't transmit that easy. If it did there just wouldn't be any bats left anywhere.

    Bats are good things, BTW. Just know one flopping around on the ground in the daylight is most likely sick with something. Most likely rabies. Even so, rabies has not wiped bats from the face of the earth.

  • 09/27/2012 05:55pm

    I agree with your perspective on this. Over a decade ago I was involved with wildlife rescue and the US was attempting to vaccinate wild raccoons with vaccine drops from the air to curb it. I really can't see it being extinct in North America, but would like to believe that it is being well controlled so animals don't have to die because of it.

    My understanding, like yours, is that biting is how it is transmitted, or possibly transplants if a victim's organs are used.

  • 09/27/2012 10:43pm

    If you go to the CDC website you can find all the statistics you want. Rabies has to be injected into your system - bite, cut, transplants are documented on the CDC site.

    It is my understanding that air droped vaccines were used along the Texas/Mexico border to eliminate rabies there. That I am totally amazed with. So many people there do absolutely NOTHING for their dogs, and still the air drops eradicated rabies.

    It is also my understanding that they are using air drops to keep the raccoon strain along the east coast from traveling further west. They have been "holding it at bay" there. Perhaps they will get to the point of eliminating it. About 10-15 years ago they stopped an outbreak in coyotes in Ontario Canada with air drops.

    The CDC website has a kazillion maps showing where and what kind of rabies cases are reported. They also list the human cases and where the human contracted it.

  • 09/27/2012 11:00pm

    When I was involved it was the air drops on the eastern seaboard, and hopefully preventing it from spreading up to Canada, from our perspective.

    The point is, there is wildlife out there in North America that still carries this disease, and when it is PRUDENT, I think the shots or boosters should be given. Someone commented that rabies had been eradicated if I remember correctly and that just isn't the case. If owners think it doesn't exist in North America, they are likely not to want to spend the money on vaccines, or even titers, (spelled titres here for the perfectionists), which is why we end up with laws insisting that everyone have the vaccine. Too bad some people can't use common sense over falsely saving money. No second step thinking done.

  • 09/28/2012 11:58am

    When I was involved it was the air drops on the eastern seaboard, and hopefully preventing it from spreading up to Canada, from our perspective.

    Yes, I know the air drops were used in that area. But also to keep it from spreading west. This is the raccoon strain rabies. I am the one that made the comment that CANINE STRAIN RABIES has been eradicated. That is straight out of the CDC's annual reports. Eradicated since the 70's.

    YES, it would be prudent to vaccinate in areas where there is endemic rabies in native species, such as along the eastern seaboard. However, I do have a problem with making it criminal to not vaccinate in areas where there is minimal risk of exposure and minimal cases of rabies (of any strain).

    Bats are the number one carrier and our brilliant government scientists need to figure a way to get a vaccine into them. Meanwhile, I have only seen one bat on the ground in my entire life (71 years). That was after a horrid storm and I don't think it was rabid.

    Smallpox has been irradicated and polio very close to it. They didn't do that by vaccinating everyone in the entire world. They did it by vaccinating around outbreaks and keeping the outbreaks contained. That is a proven method.

    Meanwhile, dog owners are criminals if they don't vaccinate. That is just wrong. Profitable for veterinarians, but still wrong.

    When these laws originated, rabies was just about endemic EVERYWHERE. That is no longer the case.



  • 09/30/2012 12:48am

    The problem with "minimal risk" in rabies is that it is not "no risk." If it was minimal risk to the dog alone, that would be one thing. But people are involved as well, as no dog owner can ever 100% guarantee their dog will never bite someone.

    If a dog bites a person, there is no way to know for sure if that dog or that person has rabies without killing it. By the time signs show up, it is too late to initiate treatment. Just because "dog strain rabies" is eradicated does not mean they cannot be infected with other strains. They are no longer the major reservoir, but they are still a possible source of infection. I'd much rather any dog or cat that bit me is up to date on the vaccine, and I'd be much less likely to push for euthanasia and testing.

    As for why the vet must administer, the biggest reason is that if it was permitted to be administered by the owner, there is no accountability; you could order the vaccine and toss it in the trash, you could store it at the wrong temperature, you could lie about which dog received it, you could miss the subcutaneous injection and go out the other side without noticing. With vets, the vaccine was given by a professional with training in both when it is safe to administer the vaccine and how to do so.

  • 10/02/2012 06:52pm

    Currently our children (and all of us) are more at risk from eating peanut butter than they are of getting bit by a rabid dog. Is it criminal to sell contaminated peanut butter? Will anyone be at risk of being sent to jail for contaminating peanut butter? or for allowing contaminated peanut butter to reach the market? Not likely.

    Yet, dog owners risk jail time if they don't have a vet vaccinate their dog against a non-existent strain of rabies in order to protect the dog from contracting any other strain of rabies (minimal risk). That is just wrong.

    I would expect a vet to say those things. It is also the vets that make the money off these vaccinations. That is no small matter. I've heard charges as high as $50 for the vaccine PLUS an "office visit" charge on top of that. For a vaccine that can be purchased for as little as $1.50 per dose? That is just wrong.

    People are not nearly as stupid as you would have us believe. Those who are not comfortable giving a shot would certainly present their dogs at a vets for a shot. Those who are would most certainly give their own and at much reduced cost there would likely be more shots given in the long run.

    I, for one, am extremely offended by your remarks concerning the dog owning public. The training involved is just not all that much and for you to say those things about people in general and the "accountability" remark is just disgracefull!

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