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Titration: sense and nonsense

Titration involves checking in the blood whether there are still enough antibodies present against a specific disease. This can be considered an alternative to vaccination.

The vets at Iscavets Veterinary Practice have looked into this new trend and would like to provide ready and clear information.

What is the point of titer tests?

The presence or absence of antibodies could tell whether revaccination is needed. This could also be useful for an animal with an unknown vaccination history or one that easily shows side effects to a vaccination. You could also use this test for puppies and kittens to check when the antibodies they got from the mum have dropped sufficiently so that they are not vaccinated too early.
While this seems very logical and useful at first glance, there are some pitfalls.

Pitfalls compared to human medicine

Titer determination is well established and reliable in humans for several reasons:

  • The determination is standardised, i.e. there are clear guidelines regarding how to perform the test and how to interpret it.
  • Studies have been carried out on similarity between the results obtained on the same sample with different analytical methods, with the same sample by multiple investigators and with the same sample by the same investigator at different times.
  • The studies were conducted on large populations and published in reputable scientific publications.
  • The occurrence of diseases is permanently recorded, so the reliability of vaccines and of titer tests is also permanently monitored.

These comprehensive studies are lacking for our small pets. And for the few studies that have been published, the study design is such that you have to be very careful when generalising the conclusions from the research.

Pitfalls around testing methodology

Rapid tests give a quick result that is semi-quantitative. This means you know whether there are antibodies or not but you don’t know how many there are. Moreover, they do not specifically measure the antibodies that are important for protection against disease. Tests in a laboratory are quantitative (you know exactly how many protective antibodies are left).Also, the different steps have to be completed in a meticulous manner. Moreover, there is no detection system to show that the test has been performed correctly. For example, a test that is too cold can give incorrect results. Or a part of the test where the time has not been precisely respected.

Laboratory tests are quantitative. The results are more reliable. They detect antibodies that are important in preventing disease. You don’t have the result immediately though, which can mean an extra visit to the vet. Note that the right test gives results in titer, and not in units.

Moreover, you should not forget that every test has limitations, with false positives (the test says there are antibodies but there are none) causing particular concern.

Pitfalls around diseases

Titer testing is only possible for a limited number of diseases: distemper, parvovirosis and hepatitis in dogs and feline distemper in cats. The test against sneezing disease is not reliable. The test does not exist for rat disease (leptospirosis), bordetella and parainfluenza (contagious canine cough), feline sneezing disease (herpes, calici and chlamydia) and feline leucosis. Vaccination against these diseases should be done annually anyway.

Pitfalls around interpretation

What do you do with the result? When do you have enough correct antibodies to give sufficient protection? Actually, this is not yet known. Moreover, immunity is a complex issue, where disease or not depends on the interaction between the animal, the pathogen and the environment. So it can be misleading to make a prediction based on a titer.

Also, such titer determination is only a snapshot in time. From the antibody titer, it is not possible to predict how long the animal will be protected. This test should therefore be repeated regularly. For puppies and kittens that still have antibodies from the mother, the test even has to be repeated every 2 to 3 weeks, which raises the question of whether this frequent blood sampling is pleasant for the animal and whether a gap in protection could occur.

If the titer is too low, vaccination still has to be done, sometimes even against more than anticipated because not all fractions are available separately. Knowing that the blood test is already more expensive than the vaccination itself, the costs can be high.

What does veterinary practice Iscavets do?

We have decided not to go along with this hype. Its usefulness is very limited and it can give a false sense of security. Most diseases vaccinated against are fatal, the cost of treatment can be high and some diseases are contagious to humans. The risk of side effects is extremely low (0.004% in dogs and 0.005% in cats). Vaccination is a simple cost-effective act that has already saved many human and animal lives.

We do follow the most recent vaccination guidelines of the WSAVA (World Small Animal Veterinary Association), the AAHA (American Animal Hospital Association) and the ABCD (Advisory Board on Cat Disease) whereby we establish an individual vaccination schedule according to the animal’s living conditions. Exactly against the diseases that can be titrated for, the vaccination only needs to be repeated every 3 years. In this way, we arrive at a tailor-made vaccination schedule in which most animals do not receive the same vaccinations every year. This method avoids over-vaccination, while guaranteeing protection for your favourite animal.

We make an exception for animals that have a history of reactions to vaccines, that have an autoimmune disease, or when the owner is unwilling to have their animal vaccinated without titer testing. In these cases, we have the test performed in a reliable lab.