PEER REVIEwEd

VITAL VACCINATION SERIES

Antibody
TiTers
versus VaccinaTion
Richard B. Ford, DVM, MS, Diplomate
ACVIM & ACVPM (Hon)

T
he publication of vaccination guidelines for dogs CORRELATION OF TITERS & IMMUNITY
and cats (see Links to Vaccination Guidelines, Antibody titers measured in laboratories and by in-clinic
page 38)—intended to provide useful insights on and antibody test kits typically record results as positive or
the selection and use of vaccines—also elicited some negative, and include a brief description of the result’s sig-
degree of controversy regarding implementation of nificance. However, questions remain:
these vaccination recommendations in practice. • How well does a positive antibody titer (or test kit result)
correlate with protective immunity in a patient?
DURATION OF IMMUNITY CONCERNS • How well does a negative titer (or test kit result) corre-
In particular, the recommendation to administer core late with susceptibility in a patient?
vaccines to adult dogs and cats at 3-year intervals (or When interpreting antibody titers, a few facts must be clear:
longer) rather than annually resulted in differences of 1. The only true test of protective immunity involves
opinion among veterinarians. After all, veterinarians exposure (challenge) to a virulent pathogen in which
have been recommending annual boosters for years, nonvaccinates (controls) are infected and manifest clini-
doing so in accordance with manufacturer recommen- cal illness while vaccinated animals remain healthy. Ani-
dations. mal vaccines are licensed based on this premise.
Therefore, the growing group of veterinarians who 2. Interpreting antibody test results depends on un-
were skeptical of triennial vaccination recommenda- derstanding what results do and do not represent.
tions began measuring antibody titers from individual In the clinical setting, antibody levels offer diverse and
patients to assess duration of immunity (DOI) and de- distinct clinical applications (see It’s All About PIE,
termine whether a patient required revaccination. As page 36).
demand for vaccine titers increased, veterinary labo- 3. Different classes of antibody, also called immuno-
ratories began offering antibody titer panels for dogs globulin (Ig), have specialized functions (identified
and cats while 2 companies developed in-clinic anti- and categorized as IgA, IgG, IgE, or IgM). In veterinary
body tests. medicine, the antibody titers used to assess protective
With the increased focus on antibody titers, additional immunity typically represent the IgG class.
questions were raised: 4. When using an in-clinic test kit to measure (qualitative or
• What are the indications for performing titers? semiquantitative) antibody levels, results are reported
• When interpreting antibody titers, what test limita- as either positive (indicates protection) or negative
tions apply? (indicates susceptibility) and must be correlated with
• How should test results be interpreted when making gold standard laboratory tests, such as virus neutral-
vaccination decisions for individual patients? ization (VN) or hemagglutination inhibition (HI), in order

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to accurately represent a defined threshold of antibody. dard antibody test for FHV-1 (VN) and protection is
Both in-clinic tests have been correlated through VN, HI, only fair; cell-mediated immunity is a better correlate
or challenge testing results. While the correlation studies of protection against FHV-1.
were conducted independently through universities, the • The correlation between the gold standard test for FCV
data is available through the respective companies that (VN) and protection is fair to good.
manufacture the in-clinic test kits.
Today, in-clinic titer test kits for canine distemper (CDV), Rabies
canine parvovirus (CPV), canine adenovirus (CAV), and fe- Rabies antibody titers, as determined by fluorescent an-
line parvovirus (panleukopenia, FPV) correlate well with tibody virus neutralization (FAVN), are only available
appropriate gold standard tests. Therefore, when these in- through a limited number of certified laboratories. It is im-
clinic tests are performed properly: portant to note that a rabies virus antibody titer cannot be
• A positive test result indicates the patient does have interpreted as an index of immunity in lieu of revaccination.
protective levels of antibody against the virus.
• A negative test result indicates the patient does not
have protective levels of circulating antibody. Howev- Factors that influence antibody response
er, a negative test result does not necessarily define
following vaccination include:
susceptibility.
• age • Genetics
• antigen type • Maternally-derived
• Vaccination history antibody (Mda)
IT’S ALL ABOUT PIE • Health status
• Protection (P): Some, but not all, antibody results
correlate well with protection (eg, canine and fe-
line parvovirus). a patient with a positive titer or
test result for parvovirus antibody can be consid- INDICATIONS FOR ANTIBODY TESTING
ered protected. The following indications apply to antibody tests for CAV-
• Infection (I): on the other hand, antibody pres- 1, CDV, CPV, and FPV because these results correlate well
ence can represent evidence of active infection with gold standard testing:
(eg, feline immunodeficiency virus).
• Exposure (E): other antibody test results indicate 1. Evaluation of Immune Response Following Initial
prior exposure to an infectious agent (eg, ehrlichi- Administration of Core Vaccines
osis) or vaccine (eg, rabies) and do not predict ei- If a client would like to determine whether a young dog/
ther protection or active infection. cat responded to the initial vaccination series (usually 3
doses), in-clinic test kits provide an excellent means of
identifying those that did respond versus those that did
ANTIBODY DEVELOPMENT LIMITATIONS not and, therefore, remain susceptible.
Seroconversion, the antibody response that follows vacci-
nation, can be identified for most vaccines administered to 2. Management of Infection Among Vaccinates
dogs and cats. However, the development of antibody does For veterinarians faced with treating confirmed parvovi-
not necessarily equate to protective immunity. rus infection in a well vaccinated dog or cat, antibody test-
ing can be used to rapidly determine whether the affected
Feline Calicivirus &
Herpesvirus
• Even if antibody test TABLE 1. Tests to Determine Immunologic Protection
results are positive VIRUS APPROPRIATE TESTS
after feline herpesvi- Rabies rabies antibody titers are determined by FaVn. Test results cannot be
rus (FHV) and feline used as an index of immunity in lieu of revaccination.
calicivirus (FCV) vac- CANINE
cination, results do
Adenovirus in-clinic titer test results correlate well with gold standard testing (Vn).
not correlate well
with protective im- Distemper virus in-clinic titer test results correlate well with gold standard testing (Vn).
munity; these results Parvovirus in-clinic titer test results correlate well with gold standard testing (Hi).
are not generally rec- FELINE
ommended for use Calicivirus The correlation between gold standard testing (Vn) and protection is
when making vacci- fair to good.
nation decisions for
Herpesvirus The correlation between gold standard testing (Vn) and protection is
an individual cat.
only fair; cell-mediated immunity is a better correlate of protection.
• The correlation be-
tween the gold stan- Parvovirus in-clinic titer test results correlate well with gold standard testing (Hi).

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TABLE 2. In-Clinic Antibody Titer Test Kits

TiterCHEK VacciCheck Antibody Test Kit
Manufacturer Synbiotics corporation (synbiotics.com) biogal Galed laboratories (biogal.co.il)
Canine Antibody cdV and cPV caV, cdV, and cPV
Feline Antibody none FcV, FHV, and FPV
Sample Serum or plasma (can use hemolyzed Serum, plasma, or whole blood (can use hemolyzed
sample) sample)
Test Time 15–20 min (minimum) 21 min (minimum)
Results Qualitative: Positive or negative Semiquantitative (based on color): negative, low
positive, significant positive, or high positive

animal developed a protective immune response follow- However, with regard to rabies vaccination, veterinarians
ing the initial vaccination series. must follow state or local laws.
• A positive antibody test suggests the vaccinated patient
was infected during a period of susceptibility (eg, in the 6. Management of Infection Risk Among Animals
presence of MDA). Entering a Shelter
• Patients with a negative test result are likely to be sus- Immunization status of young animals presented to ani-
ceptible (genetic) non-responders (or low-responders). mal shelters is often unknown. Because the infection risk
• The antibody test does not distinguish vaccine-induced among shelter-housed dogs and cats is high, determining
seroconversion from that caused by infection. antibody status of an animal at time of entry allows vacci-
nation and separation (foster) of animals deemed suscep-
3. Determination of Antibody Level in Lieu of Revaccination tible until a positive test result is obtained.
For patients with a history of a known, or suspected, seri-
ous vaccine adverse event (reaction), evaluating the level 7. Management of Outbreaks Within an Animal Shelter
of antibody will determine whether the patient has previ- Antibody test kits offer shelters a management advantage
ously developed a protective immune response to vaccina- when faced with an infectious disease outbreak involving
tion. Patients with a positive test result can avoid revacci- CDV, CPV, or FPV. Identifying and separating animals with
nation and potential risk for an adverse event. positive (protected) test results from those with negative
If, on the other hand, a patient with a history of a seri- (susceptible) results may help avoid unnecessary euthanasia.
ous vaccine adverse event is tested for antibody and has a When feasible, susceptible animals should be isolated
negative test result, the decision whether or not to admin- from the general population, which limits propagation of the
ister vaccine is more complicated because: outbreak. Isolated, seronegative survivors can be placed or
• Among previously vaccinated animals, immune mem- adopted once the incubation period for the infectious agent
ory (B-lymphocytes) can be sustained for many years has passed (2 weeks for CPV and FPV; 6 weeks for CDV).
despite declining antibody levels; exposure to a patho-
genic virus (eg, distemper or parvovirus) can result in a
rapid and protective anamnestic response. CORE VACCINE ADMINISTRATION &
• Prior history of a vaccine adverse reaction is not predic- ANTIBODY TESTING
tive of future risk. • current vaccination guidelines recommend ad-
• Immunization may not be optional, regardless of the an- ministration of the last dose of core vaccines
tibody status of the individual (eg, rabies). at 14 to 16 weeks of age in puppies and 16
weeks of age in kittens.
4. Assessment of Adult Dogs & Cats with an
• antibody titers may be determined as early as 2
Unknown Vaccination History
to 4 weeks following completion of initial vacci-
Clientele who have adopted an adult dog/cat that has no
nation series.
known vaccine history may elect to avoid vaccination if a pro-
tective level of immunity can be determined serologically. • a puppy or kitten that is seronegative at 18
weeks of age should be revaccinated not less
5. Antibody Testing in Lieu of Annual Revaccination than 2 weeks following the last dose. antibody
International guidelines for administration of core vac- testing can then be performed as early as
cines to adult dogs and cats consistently recommend re- 2 weeks following administration of this last
vaccination schedules of no more often than every 3 years vaccine dose.
for core antigens (CAV-1*/CDV/CPV and FCV/FHV/FPV).

*All antibody tests detect antibodies against CAV-1; however, the vaccine antigen protects against CAV-2 (a respiratory pathogen), which also cross protects against the
more serious, systemic CAV-1 (canine hepatitis virus).

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LINKS TO VACCINATION GUIDELINES Richard B. Ford, DVM, MS,

• 2011 AAHA Canine Vaccination Diplomate ACVIM & ACVPM
Guidelines: aahanet.org/Publicdocuments/ (Hon), is Emeritus Professor
canineVaccineGuidelines.pdf of Medicine at North Carolina
• 2006 American Association of Feline State University’s College of
Practitioners Feline Vaccine Advisory Panel Veterinary Medicine. He is a
Report: catvets.com/uploads/PdF/2006 retired Brigadier General from
Vaccination Guidelines JaVMa.pdf the USAF Reserve, where he
• 2010 WSAVA Guidelines for the Vaccination was assigned to the Office
of Dogs and Cats: wsava.org/sites/default/files/ of the Surgeon General at the Pentagon. Dr. Ford
VaccinationGuidelines2010.pdf is also a past president of the NAVC Conference
and continues his role as a member of the scientific
program committee. His clinical interests are in the
INTERPRETATION OF ANTIBODY TEST RESULTS field of companion animal infectious disease; he is
The following interpretations apply to antibody test results a prolific author and serves on both the AAHA Ca-
for CAV-1*, CDV, CPV, and FPV, reported by a reputable di- nine Vaccination Task Force and AAFP Feline Vac-
agnostic laboratory or obtained from an in-clinic test kit: cination Advisory Panel. Dr. Ford received his DVM
1. A positive antibody test result in an unvaccinated, but from Ohio State University and completed a small
healthy dog or cat suggests prior exposure to and recov- animal internal medicine residency at Michigan
ery from infection; the patient has protective immunity. State University. He held a previous faculty position
2. A positive antibody test result in a previously vacci- at Purdue University.
nated dog or cat correlates well with protective im-
munity.
3. A negative antibody test result in a previously vacci- Schultz Rd, Ford RB, Olsen J, Scott F. Titer testing and vaccination: A new
nated dog or cat must be interpreted on the basis of look at traditional practices. Roundtable Discussion. Lenexa, Kansas:
Veterinary Healthcare Communications, 2002, pp 1-16.
age and prior vaccination history. Twark L, dodds wJ. Clinical use of serum parvovirus and distemper virus
• Negative test result in protected patient: Over time, antibody titers for determining revaccination strategies in healthy dogs.
antibody levels in a previously vaccinated adult dog or JAVMA 2000; 217:1021-1024.
waner T, Mazar S, Keren-Kornblatt E. Application of a dot enzyme-linked
cat that is not revaccinated (or naturally exposed) may immunosorbent assay for evaluation of the immune status to canine
fall to negative levels. Memory cells (B-lymphocytes), parvovirus and distemper virus in adult dogs before revaccination. J Vet
however, can persist longer than antibody. Exposure Diagn Invest 2006; 18(3):267-270.

to virulent virus is expected to rapidly boost the pa-

tient’s antibody response and protect.
• Negative test result in susceptible patient: A puppy
or kitten that is antibody negative following adminis-
tration of initial core vaccine series is considered sus-
ceptible to infection if exposed. These patients may
be (genetic) non-responders (or low-responders) or
received the vaccine during a period when interfering
levels of MDA were present. n

caV = canine adenovirus; cdV = canine distemper; cPV =

canine parvovirus; doi = duration of immunity; FcV = feline
calicivirus; FHV = feline herpesvirus; FaVn = fluorescent
antibody virus neutralization; FPV = feline parvovirus
(panleukopenia); Hi = hemagglutination inhibition; ig =
immunoglobulin; Mda = maternally-derived antibody; Vn =
virus neutralization
Suggested Reading
Greene CE, Levy J. Immunoprophylaxis. In Greene CE (ed): Infectious
Diseases of the Dog and Cat, 4th ed. St. Louis: Elsevier-Saunders, 2012,
pp 1163-1205.
Greene CE, Vandevelde M. Canine distemper. In Greene CE (ed): Infectious
Diseases of the Dog and Cat, 4th ed. St. Louis: Elsevier-Saunders, 2012,
pp 25-42.
Gill M, Srinivas J, Morozov I, et al. Three-year duration of immunity for canine
distemper, adenovirus, and parvovirus after vaccination with a multivalent
canine vaccine. Intern J Appl Res Vet Med 2004; 2(4):227-234.
Schultz Rd, Conklin S. The immune system and vaccine challenges for the
21st century. Comp Cont Ed Pract Vet 1988; 20:5-18.

38 Today’s Veterinary Practice May/June 2013