Answer:
The patient in this case had no history of
vaccine-associated adverse events, so the apparent vaccine-associated adverse
event that occurred when Dr. A administered the final set of puppy vaccines
would be considered unavoidable and an inherent risk of administering vaccines.
Because Dr. A had no knowledge of the patient having an allergy to vaccines,
this incident is considered an inherent risk and not due to negligence
(avoidable complication). Malpractice insurance policies do not provide
financial compensation in situations that are considered inherent risks because
they are not below the standard of care.
According to the American Animal Hospital Association’s
Vaccination Guidelines for General Practice, the vaccinations administered in
this case are consistent with the core vaccination recommendations for a
16-week-old puppy, with the exception of the leptospirosis immunization.
The American College of Veterinary Internal Medicine
identifies canines with exposure to water sources shared by wildlife such as
lakes, ponds, and streams as well as access to suburban backyards as at risk
for infection with leptospirosis and in need of immunization against
leptospirosis. Based on the client’s description of the patient’s environment
and lifestyle, Dr. A assessed the puppy to be at risk for infection with
leptospirosis and deemed the vaccine appropriate.
Canine vaccinations, including those against
leptospirosis, are rarely associated with severe adverse events. A 2005
retrospective case review (n=1,226,159) by Moore, et al, documented
vaccine-associated adverse events in only 0.038% of canine patients and did not
find vaccination for leptospirosis as a factor for increased risk on an adverse
event.
In this case, the individual animal had no previous
history of reaction to vaccination as documented by the client during the
history collection and medical records from previous vaccination appointments.
The patient showed evidence of an acute type 1 hypersensitivity reaction with
angioedema leading to facial swelling. Dr. A proceeded to provide appropriate
treatment, including recommendation for follow-up monitoring by an emergency
clinic. Dr. A went on to document the reaction in the patient’s medical record.
References:
Ford,
et al 2017 AAHA Vaccination
Recommendations for General Practice:. revised 2018, www.aaha.com/aaha-guidelines/vaccination-canine-configuration
Sykes, et al. 2010 ACVIM Small Animal Consensus Statement on Leptospirosis: Diagnosis, Epidemiology, Treatment and Prevention: Journal of American College of Veterinary Internal Medicine 2011; 25: 1-13.
Moore, et al.Adverse events diagnosed within three days of vaccine administration in dogs; Journal of American Veterinary Medical Association Vol. 227; 7:1102-1108.