Why do we Titer?

It all started with Lana's breeder, they already knew about titering. Which for us was still a gray area… we had heard of it but didn't fully know what it all entailed.

We are now fully integrated in Titeren and can now provide you with all the information.

From the facebook group: Titering with Vaccicheck.

What is titering?
By taking a drop of blood from the dog or cat, the VacciCheck antibody test can determine whether there are still enough antibodies (antibodies) in the blood. This allows you to see whether or not vaccination is required, so that the dog or cat does not have to be burdened by unnecessary and/or superfluous vaccinations. Below, we will mainly talk about the dog because that trajectory is different, partly due to the regulations, but cats can also be titrated.

Which antibodies are titrated for?
With VacciCheck, the antibodies are measured in the dog of the 3 vaccines that are in the cocktail, namely:
Canine Distemper (Canine Distemper Virus or CDV),
Infectious Hepatitis (Canine Adeno-2 Virus or CAV-2; also against CAV-1),
Parvo (Canine Parvo-2 Virus or CPV-2).
Cats are titrated to:
Feline Disease (FPV)
Herpes (FHV-1 or FHeV-1)
Calici (VCF)
Cat titers are not yet done by all doctors who titrate dogs, so always inquire well in advance whether they also titrate cats.

Why is Rabies not titrated?
Because regardless of the result (which is a completely different test) this is a legally required vaccination and no exceptions may be made by means of a test. You will therefore have to have a valid rabies vaccination at all times if the dog goes abroad.

Why is there no titration for Leptospirosis (eg Weil's disease)?
Because Leptospirosis is a bacterial infection, for which no titer determination is possible. That is possible for a viral disease. In addition, the Leptospirosis vaccination is only effective for a short period of time (it is a dead vaccine) so it is of no use.

How does it work and how long does it take before the results are known?
A drop of blood is taken from the dog and this is done in the VacciCheck. The test itself takes half an hour, but this depends on the vet's method. For example, there are vets who organize 'titer days' and then they wait until they can do as many tests as possible at once (a maximum of 12 animals can be tested with one VacciCheck) and then you may not get the results until a few hours later. If you go with a group, blood will normally be taken from all dogs first, after which the VacciCheck can be started and as soon as the results are known, the passports are filled in and signed. If necessary, the dogs are of course vaccinated. So just ask in advance about the method.

Is a titer determination officially recognised?
Meanwhile, the WSAVA, the KNMvD, the NVWA, the Dibevo and the Raad van Beheer, among others, have recognized the titer determination. This can be read in the Raadar, published by the Board of Directors, January 2015 edition, page 7 at the bottom.
Link: https://www.houdenvanhonden.nl/globalassets/raadar/2015/rvb_raadar_2015_1_januari.pdf

Guest houses are also allowed to allow dogs and cats that are titrated https://www.knmvd.nl/groepen/GGG/item/10868287/Titerbepaling-pensions-istoegestaan

Titer determination of guest houses is also allowed.
According to the NVWA, titer determinations in dogs and cats may also be used to meet the vaccination obligation of boarding houses and shelters. If the vet wants to use this, it seems appropriate for the legal vaccination requirements that are set for commercial purposes
kept dogs and cats. The vet must, however, provide a good substantiation and clearly indicate when vaccinations must be given or repeated. The titer determination relates to Parvo, HCC and Distemper in the dog, and Panleukopenia in the cat.

Is a titer determination also valid abroad?
When a dog goes abroad, a valid rabies vaccination is in any case an obligation. Look for the obligations on the various for that
designated sites (eg. www.licg.nl) and the embassy of the country concerned. Better to be overinformed and well prepared than to run into problems on the spot with all the consequences that entails.

What are the titling costs?
VacciCheck has a limited shelf life. Therefore, veterinarians who do not titrate regularly will often charge a higher price. However, if several dogs are titrated at the same time, most doctors have special favorable rates for this. After all, they know for sure that they will not be left with expensive unused tests. With one VacciCheck 12 animals can be tested. But in any case, remember that there is a very good chance that you will be ready for years after titrating 1 x, so you already put the costs of the (three) yearly vaccination in your pocket!
Prices for an individual VacciCheck are between approx. €50 and €70. For a VacciCheck with several dogs you will quickly end up with around € 40,–. Please note: when a vet in the Netherlands sends the blood to a laboratory, this does not happen with the VacciCheck and the costs are considerably higher. In addition, those results are not added to the passport and you have therefore actually had something done that is of no use to you when you need a valid passport, for example. In Belgium, the VacciCheck is used by various laboratories, so informing in advance certainly does not hurt.

When to start titering?
More and more breeders are switching to titrating first and then vaccinating. The advantage of this is that a puppy that is vaccinated at the right time only needs 1 vaccination instead of the usual 3. A puppy receives the antibodies with the colostrum from the mother in the first about 12 hours. These maternal antibodies are also known as maternal antibodies. If the mother does not have antibodies, she cannot pass them on to her puppies and they are therefore not protected! It is therefore advisable to titrate the bitch before mating and if necessary vaccinate. How long the maternal antibodies will be present differs per puppy/litter. One puppy is already through it at 6 weeks and then needs to be vaccinated, but there are also those that have no maternal antibodies until 20 weeks and only then need to be vaccinated. The most important thing to know is that as long as a puppy still has the maternal antibodies, the chance is very high
is that a vaccine will not work. That is also one of the reasons that puppies in the Netherlands and Belgium receive a puppy vaccination 3 times. This is in the hope that one will catch on. By titrating it has already been established that there are a lot of young dogs walking around (partly) unprotected the entire first year. You do not want this and is certainly not the intention of 3x vaccination. You do not want to experience Parvo and especially puppies are still very vulnerable because the immune system still has to develop fully, so titrating is a good method for not overloading the immune system unnecessarily and to determine the right vaccination moment. In most cases Parvo is therefore also taken as the starting point
for the correct time of vaccination.

6-7 weeks
At this age, the first titer determination can already be done. Based on the results, it is determined what the next step will be. Suppose the puppies already no longer have the maternal antibodies, then they can now receive the DHP cocktail. Then the advice is to titrate again a month later to see if the vaccination has taken effect so that the puppy is well protected and then further puppy vaccinations are no longer necessary. We call this a control titer. If the puppies are still provided with the maternal antibodies, it is determined on the basis of the results when the next time titration or vaccination can be done. Titrating a litter should always be done in good consultation with the future owners and is more intensive than just getting a vaccination. On the other hand, the young puppy is not unnecessarily burdened with vaccinations and the extra costs in the beginning
can easily be recouped afterwards because the dog no longer needs to be vaccinated in the coming years and there is much less chance of health problems that can lead to unnecessary vaccinations. On the photo below you see on the left a titer determination of a puppy of 6 weeks and on the right of 10 weeks. This clearly shows that the values have halved in 4 weeks. At the age of 14 weeks she was vaccinated and about 4 weeks after that do a control titer determination to check whether the vaccination has been successful. After a year you titer again and when it is positive again, you can sign off for a number of years. This puppy does not need to be vaccinated for the next 5 years and there is even a good chance that with this one vaccination she will be protected for life at the right time. We'll see what the titer determination shows in 5 years! In the meantime, it has therefore been decided that signing off may take place for a maximum of 3 years.

9 weeks
When the puppy in the litter has already had the 6 weeks vaccination (Distemper and Parvo), it is still possible to titrate. It saves at least 1 puppy vaccination, but more importantly: you will in any case find out whether the puppy is protected or not. Based on the results, it can be determined whether it is clear whether the Parvo antibodies are due to the 1st vaccination or whether these are still the maternal substances. By titering you can therefore see when the antibodies have disappeared so that vaccination can be given at the right time.

From 12 weeks
The puppy has had all 3 puppy vaccinations but is the puppy protected? That turns out not to be the case in many cases. In this photo you can see a titer result of a Golden Retriever of 5 months. This one 'cleanly' had all 3 puppy vaccinations and appeared to be only protected against infectious Hepatitis. This means that this dog, at the time of the 12 weeks vaccination, most likely still had the maternal antibodies of Parvo and Distemper, so the vaccination did not work. The owners of this dog were sacred in the assumption that their dog was therefore fully protected. Veterinarians unfamiliar with titrating may want to give young dogs another booster vaccination at the age of 1 year as part of the primary vaccination course. It can hardly be otherwise than that it is known that the 3 puppies
vaccinations do not offer guaranteed protection. It is therefore certainly useful, even when the puppy has had the 3 puppy vaccinations, to have a titer a month after the last vaccination to be sure whether the puppy is also
really protected. Then another control titer a year later and if the result allows it, a longer term can be signed off. 

From 1 year and older
Instead of giving the DHP cocktail indiscriminately, you can have the dog titrated first to see if the dog needs to be vaccinated. As long as the dog has antibodies, vaccination is of no use at all. It is not the case that the dog would then get more antibodies, because the vaccination will then not work and can even capture antibodies. So the vaccination has completely no use but meanwhile, the dog is injected with an unnecessary dose of vaccines.

There are vets who use VacciCheck and want to repeat it every year. Because it is easy for an experienced veterinarian to interpret how long the animal will still be protected by antibodies, this is a method that costs you unnecessarily. The WSAVA, which sets out the guidelines with regard to vaccinations, has indicated that in the event of a positive titer result it is not justified to titer annually and that it can be repeated 3 years after the titer determination. This is also supported by the Faculty of Veterinary Medicine in Utrecht. Also check the manual of the supplier of the VacciCheck in our files.

How do you (hopefully) find out if you are dealing with a doctor who has experience in taking and reading titer determinations?
Call the relevant doctor/clinic and the following questions will help you a lot.
1. Do you also do the VacciCheck / titer determination in dogs?
2. For how long do you issue a titer determination?
If a general answer is given here, such as 1 year, then you are most likely dealing with a doctor who does not read a result but sets a standard term.
3. What are the costs for the VacciCheck?
4. What are the costs if it is necessary to vaccinate?
The costs for the VacciCheck normally include the consultation and blood draw. This means that, if vaccination is required, the vaccination is much cheaper than 'normal' because your consultation has already been paid for. However, there are also known practices of doctors who then charge the full rate and therefore
charge the consultation again. Always ask whether the individual vaccinations can also be given separately because Parvo is a vaccine that can also be obtained separately and if there are still sufficient antibodies for infectious hepatitis and not for Parvo and Distemper, a DP vaccination can be given. Hepatitis is not available separately. 

What if you do need to be vaccinated?
That can in principle happen immediately. A doctor who looks more at the well-being of the dog instead of the contents of his/her wallet will always look at which vaccination is most suitable and which causes the least 'damage' instead of immediately putting the big cocktail in it. Of course it can also be the case that it is necessary so it is not necessarily bad. Substantiation about the why often makes things much clearer. Incidentally, it is nonsense that a cocktail should always be given WITH the leptospirosis vaccine. Please note: it is easy for a vet to do this with, for example, the leptospirosis vaccine, because this vaccine can then be used as a solvent for the DHP. A responsible veterinarian will advise never to have multiple vaccinations at the same time because this is a huge attack for the dog. So this one will be the DHP with a separate
solvent (physiological saline) and advise to come back later for a possible Leptospirosis or Rabies vaccination. Incidentally, it is advisable to first make a well-considered decision yourself whether vaccination of Lepto is necessary. It is not a harmless vaccination. In front of
more information can be found in the group “Vaccination Lepto 4 – our experiences.”

If one (due to ignorance) does not want to accept a titer determination:
The purpose of a vaccination is to ensure that a dog has adequate protection against certain diseases. By doing a titer determination you can therefore see whether the dog is sufficiently protected by antibodies and therefore will not be a danger to itself and/or the environment. The Board of Directors has also recognized the titer determination since January 2015 and the same applies to the NVWA, which also gives pensions the opportunity to accept titer determinations. So there is no reason at all not to accept titer determinations. A vaccination does not always have to work and does not guarantee immunity, so by titrating you at least know whether and to what extent your dog is protected. The umbrella trade union DIBEVO has also advised its affiliated members (including pensions) to accept titer determinations. Often, however, it is ignorance so give us a heads up if you run into something and we will see if we can help you with that.

How do you read the titer strip?
Hold the strip by the wide part with the dots facing down. This is how the titer should be read. When you turn the strip around, you get completely different results. You can hold the strip by the wide part. You will also see the sequence of some strips as a mnemonic.
1. Top dot = the reference dot. This has the result S3 as an indication. That absolutely does not mean that when a dot is lighter, there is insufficient immunity. Because S2 is also still positive and the dog still has antibodies. After all, positive is positive!
2nd dot is Infectious Hepatitis
3rd dot is Parvo (the most important!)
4th and bottom dot is Distemper.
As long as there are still antibodies present, there is a very good chance that a vaccination will not work. That is why the starting point for puppies is mainly the value of the Parvo. Parvo still occurs, Distemper less and infectious Hepatitis very rare (but due to the large number of imported dogs from abroad it is important to remain alert to this). It is therefore especially important that the dog is protected when there are titres that are at 0 or 1, vaccination is recommended.

The tests work with shades of gray. The top dot is the reference dot and always indicates the value S3. The darker the dots underneath (relative to the reference dot) the more antibodies the dog has. So with a very light gray the dog has fewer antibodies than when the circle runs into the black. But very important is whether they have antibodies or not. So positive is positive and with a positive titer there is no need to vaccinate! Now this seems very simple, but the dark color on one strip can have a very different value than the same looking dark color on another strip. So comparing doesn't apply because it's apples to oranges. The starting point is the control dot and it can vary in color. That is why it is important that a doctor is familiar with how to read such a strip, and this is mainly achieved by having the knowledge that is required for this. The test also includes a color strip next to which the strip of the titer determination can be placed, making the values easy to read. Nowadays, even specially developed software is used for this. Always make sure that you get the strip and the values are stated in the passport, with an end date, signature and stamp of the vet. Then only it is valid.

The interpretation.
Interpreting the VacciCheck is primarily something that can be acquired through knowledge and experience. Results from puppies should be interpreted very differently than from adult dogs. First of all, of course, the result of the VacciCheck, but there are also more factors that can play a role, such as age, health and the vaccinations that have already been given. When the results on 1 strip differ greatly, such things can play an even more important role. That is why interpretations can sometimes differ, but when you ask the vet why he / she has come to this interpretation, you will get more clarity and insight about this. If you still have doubts about an interpretation, you can always consult to have the result assessed by another vet before immediately vaccinating. Because vaccinating in vain would of course be a shame and nullifies the usefulness of titering.

Where in my region can I have a VacciCheck done?
The list that we, the management of Titering with VacciCheck, maintain is a list of practices that we know are titrating according to the latest guidelines and
of which we have actually seen the evidence and/or who have been trained or retrained according to the latest guidelines so that their knowledge is up-to-date.

On the website of the supplier of the VacciCheck (https://www.nmlhealth.com/VacciCheck) is a list of doctors/clinics that take the VacciCheck at NML health.
Please note: only addresses that purchase directly from NML health VacciCheck are listed here. However, VacciCheck is also available through various veterinary wholesalers, so they are not automatically included on this list. The addresses on this list therefore do not mean that they also regularly titrate and/or work according to the latest guidelines. You could also see if you can get a number of dogs together and then ask a vet to come to the location.

This document has been prepared for information purposes only, where on our own responsibility and
risk can be used. Therefore no one can ever be held liable
be made on its contents.