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| Vital Vaccination: Kennel cough ReVisited today's Veterinary Practice July/August 2014 76 tvpjournal.com administered in accordance with the manufacturer's recom- mendations. See The Do Nots of Vaccine Administration. 6. Simultaneous Administration of Multiple Vaccine Types Parenteral CDV + canine parvovirus (CPV) + CAV-2 vac- cine combined with CPiV is among the multivalent vac- cines most commonly administered to dogs in the U.S. and Canada. Because intranasal B bronchiseptica vaccine may also in- clude vaccine against CPiV or CPiV + CAV-2, dogs can re- ceive both parenteral and intranasal vaccine for the same virus. There is no risk associated with doing so, even if ad- ministered during the same appointment. Immunologically, dogs vaccinated against B bronchisep- tica, CPiV, and CAV-2 by both parenteral (circulating IgG) and mucosal (secretory IgA) routes (oral and intranasal) at the same time may derive a greater degree of protec- tion than those vaccinated either parenterally or mucosal- ly. However, no scientific studies exist that confirm this. PUBLIC HEALTH CONSIDERATIONS Published reports document the role of B bronchiseptica as a primary respiratory pathogen in humans, and it can be transmitted from dogs, cats, and rabbits to humans and other animals. Infection Risks When exposed to an infected dog or cat, humans are at low risk for infection. However, greater risk for infection exists in immunocompromised individuals, children, and individuals working in high-density animal facilities (eg, shelters, rescue kennels). 18,19 Postvaccinal sneezing and/or coughing are commonly re- ported in dogs that recently received intranasal vaccines. Re- ports of human infection with B bronchiseptica have raised concerns about administration of avirulent live (oral or intrana- sal) vaccine to dogs owned by immunocompromised individu- als and families with young children (see Was It the Vaccine?). Studies on B bronchiseptica Vaccine Administration A study published in 2002 15 advanced the notion that mucosal administration of vaccine would be less effective in stimulating secondary (versus pri- mary) immune responses. this study popularized a vaccination protocol that involves initially adminis- tering an intranasal vaccine; then administering all subsequent vaccines parenterally in order to effec- tively booster serum antibody titers. A study published in 2007 16 highlighted immuno- logic and clinical advantages of intranasal vaccina- tion over parenteral vaccination. dogs vaccinated with intranasal vaccine: • Developed local immunity (B bronchiseptica-spe- cific iga titers in nasal secretions) • Developed significant serum antibody titers • Following challenge, had significantly lower shed- ding and lower cough scores compared to dogs vaccinated parenterally. A 2013 study 14 compared the quality of protection in dogs vaccinated against B bronchiseptica by in- tranasal, oral, and parenteral routes. Following chal- lenge, cough scores in all dogs were reduced when compared to control dogs. however, dogs vacci- nated by intranasal and oral routes had significantly lower cough scores compared to those vaccinated parenterally. The Do Nots of Vaccine Administration DO NOT ADMINISTER: 1. an intranasal B bronchiseptica vaccine by the oral route because concentration of B bronchiseptica in an intranasal vaccine is less than that in an oral vaccine. 2. the intranasal vaccines containing modified- live viruses (CPiV and CAV-2) by the oral route because an intranasal vaccine, if administered orally, is not expected to induce protective immunity. 3. the parenteral B bronchiseptica vaccine by the oral or intranasal route; the parenteral vaccine is an inactivated cell culture extract and not effective if administered orally or intranasally. 4. an oral or intranasal (attenuated) B bronchiseptica vaccine by the parenteral route because some dogs may develop injection-site granulomas or abscesses (Figure). 5. the oral or intranasal (attenuated) B bronchiseptica vaccine by the parenteral route; rarely, may lead to nonseptic hepatic necrosis and death. 17 Figure. Spontaneous rupture of a subcutaneous abscess in a dog 5 days following parenteral administration of an intranasal vaccine containing avirulent live B bronchiseptica.