Equine Flu Vaccine Shortage

Vaccine Supply Update - 31 March 2023

Boehringer Ingelheim, MSD and Zoetis have released an update on their flu vaccine supplies.

Read the update

Update: 13 January 2023

Some Proteq flu has recently been released into the market but has rapidly left the wholesalers. There will not be any more Proteq flu available until the next delivery to the UK in mid-March. There is enough vaccine to meet demand, however the Vetera that has been imported from the USA expires in mid-March and will not be sold beyond the end of January 2023.

Veterinary practices that rely on Boehringer Ingelheim vaccines:

• ACT NOW to look at how much Proteq flu vaccine is in stock and how much will be needed between now and the middle of March
• CALCULATE ANY SHORTFALL that will result between now and mid-March and buy Vetera now
• If practices wait to try to buy Proteq/Vetera in February or early March you will be disappointed and are highly unlikely to be able to get alternative vaccines from other manufacturers. Please also consider previous advice that tetanus vaccines should be used sparingly.

Correspondence from boehringer ingelheim re. Supply of Proteq Flu and Proteq Flu-TE suspension for injection for horses

Full letter

Post-shortage Guidance

BEVA recommends that all horses are vaccinated against influenza. 

An initial primary course of two vaccinations must be given: the second vaccination must be administered within 21-60 days of the first vaccination.

The first booster must be administered within six calendar months following the date of the administration of the second vaccination of the primary course. Note: individual horse owners are advised to follow their vets’ advice on the intervals recommended by the manufacturer for the specific product used (typically 4 or 4-6 weeks between the 1st and 2nd vaccine and 5 months between the 2nd and 3rd vaccine).

A minimally appropriate subsequent booster schedule can be considered. Booster vaccinations must be administered at a maximum of 12 month intervals.

BEVA strongly endorses an optimal schedule achieved by increasing the frequency of boosters to within six months.

In deciding whether to follow the 'minimally appropriate' or 'optimal' vaccine schedules outlined above, BEVA urges horse owners and their vets to consider the following points:

• The primary aim of flu vaccination policies is to protect individual horses from clinical illness should they encounter equine influenza virus
• There is considerable scientific evidence to support the assertion that horses which as vaccinated at six monthly intervals are protected more effectively from clinical signs of flu than those vaccinated at 12 monthly intervals and are less likely to transmit infection.
• Additional benefit can be gained by administering boosters strategically, i.e. at the times of year corresponding with periods of increased horse gathering and consequent increased risk.
• Influenza virus spreads via the airborne route and has the ability to spread rapidly over distances in excess of those found on a typical equestrian premises, whether indoor or outdoor. Farm-to-farm airborne spread is possible in many regions of the UK.

The response to vaccination is not immediate and there must be an interval of at least seven days between the most recent vaccine dose and mixing with other horses to have some benefit from that recent vaccine. This is a particularly important point to consider when introducing a recently vaccinated new animal to a property.

OWNER FAQs

Please find below FAQs put together by BEVA providing information for horse owners on supply of the vaccine. Published on 13 October 2022.

Equine Influenza Vaccine soon to be available through Special Import Certificate (SIC)

We are pleased to report that today (30 September) both an SIC (Special Import Certificate) and WDIC (wholesale import certificate) have been granted by the VMD to allow the import of Vetera® 2XP, a combined EIV and EHV vaccine, manufactured by Boehringer Ingelheim and registered for use in the USA. If practices wish to obtain this product, they will need to obtain an SIC certificate from the VMD and can do so via the VMD website. We understand that within a couple of weeks the product will be available via veterinary wholesalers and would suggest that veterinary practices might want to start the SIC process in preparation.  

UPDATE ON DISTRIBUTION AND USE OF VACCINES - 16 SEPTEMBER

The equine influenza vaccine shortage has resulted in the need for the pharmaceutical industry, the medicines regulators, racing, equestrian sport and the veterinary sector to collaborate to protect the horse sector as a whole.

Modelling indicated that the effect of the estimated national vaccine deficit on disease outbreak risk and competition could be managed by a range of measures to extend vaccine intervals in a targeted way across the sport and leisure horse population. This required clarity from the manufacturers on supply timelines, the regulators to recognise that the shortage required direct movement of vaccines between practices, racing and equestrian sport (including the FEI) to lead with temporary rule changes, and for veterinary practices to support the initiative. If any single group failed to collaborate it was clear that horses, including young stock, would go unvaccinated and the risk of a disease outbreak would be heightened.

It was therefore testament to the corporate groups’ recognition of their important role in the UK horse sector that representatives from CVS, IVC Evidensia and VetPartners got together at BEVA Congress and volunteered to::

• Encourage their vets to extend vaccine intervals in line with the BEVA recommendations, and
• Encourage their practices, where stock is available, to collaborate with local or referring practices, who do not have sufficient vaccine, to ensure that  all high-risk patients have access to vaccinations.

UPDATE FROM THE THOROUGHBRED BREEDER'S ASSOCIATION - 16 SEPTEMBER

The TBA have issued a statement on the equine flu vaccine shortage.

View full statement

UPDATE - 15 SEPTEMBER 2022

The BHA~ have introduced, with immediate effect, a temporary extension to the six-month intervals required between booster vaccinations – wherever this may be necessary due to shortage of supply of Proteq vaccine. This decision follows consultation with the BHA Veterinary Committee and other experts in equine infectious disease.

If an attending veterinary surgeon is unable to access the Proteq vaccine, horses administered a V3 or booster vaccination during the first six months of 2022 and requiring a second dose in the second half of 2022 will not be required to receive their booster in line with the six-month intervals while this problem persists.

In the meantime, we urge trainers and veterinary surgeons to continue, where they experience no interruption to supply, to administer boosters no more than six months apart.

We believe that this strikes a proportionate balance between reducing the risk of a flu outbreak and preventing horses becoming ineligible to race or having to restart a full vaccination course during the period of potential disruption to supply.

Guidance for trainers and vets experiencing supply issues

The British Equine Veterinary Association (BEVA) is working with veterinary practices to try and expedite sharing of stocks of equine flu vaccine between veterinary surgeons, to ensure that as many horses remain eligible to race as possible.

Based on the BHA’s current understanding of the situation, if you are affected by disruption to supply of Proteq, we advise prioritising vaccination for those horses that are:

1)     Due to race internationally before the end of 2022

The extension to the six-monthly intervals confirmed today is a BHA-only decision aimed at supporting British trainers and owners, and so rules may vary across racing jurisdictions.

For example, we have been informed that France Galop will not be making similar modifications to its current vaccination protocol (i.e. they are maintaining the requirement for boosters to be administered every six months).

If you are planning to send a horse abroad to compete, please check with the jurisdiction in question at the earliest opportunity and prioritise vaccinations accordingly to ensure compliance with their Rules. 

2)     Still being administered annual boosters

Our position remains that any horse with an interval of more than 12-months between boosters will be required to re-start a new primary course. This will not be modified under the arrangements announced today.

Some horses may not yet have commenced six-monthly boosters and will therefore soon be due an annual booster. For example, a horse that received its last booster on 1 October 2021 will need a booster on or before 1 October 2022 to remain eligible to race.

Vaccination schedules once the shortage has been resolved

The BHA remains committed long-term to the re-introduction of the six-monthly vaccination requirement, which provides the best protection for the thoroughbred racing population.

At this point, Proteq’s manufacturer, Boehringer Ingelheim, anticipates that the supply issues are likely to be resolved by the end of October 2022.

The BHA will continue to monitor this situation alongside veterinary colleagues and experts in equine infectious disease, and provide trainers and veterinary surgeons with regular updates as new information becomes available.

Finally, we continue to emphasise the importance of maintaining robust biosecurity measures. As this exceptional situation continues, trainers and vets are urged to ensure effective isolation of new horses and to strongly consider preventatively PCR testing new horses for flu before allowing them into their yard.

Live discussion at BEVA Congress 2022

UPDATE - 7 SEPTEMBER 2022

Further to the update issued jointly with the British Equestrian Veterinary Association (BEVA) and the British Horseracing Authority (BHA) on 17 August, it has been confirmed there are distribution problems with equine influenza doses of Boehringer Ingelheim’s Proteq product. This is a Europe-wide issue, but the impact of a shortage of doses has hit the UK first, with a number of veterinary practices already out of stock. Early indications from the company are that the issues will continue until the end of October at the very earliest.

Read on

Flu Vaccine Shortage: Advice to BEVA Members

Introduction:

• Current indications are that the EI vaccine shortage will continue to the end of October at the earliest.
• These guidelines are designed to help minimise the impact of the vaccine shortage on disease risk and equestrian activities for this limited period.
• The advice is based on best estimates of vaccine usage amongst different groups, and of current vaccine stocks.   Basic modelling indicates that the guidance should manage the worst of the problems.  Success for the industry will be significantly more likely if practices adopt the guidance and collaborate to help each other out when required.
• On 25th August 2022 the VMD advised that, for the purpose of alleviating a temporary supply shortage that could be detrimental to animal welfare, vaccines can be moved between practices as long as they’re supplied in appropriate packaging for maintaining temperature. From a traceability point of view, the VMD would encourage the practice to sell the vaccines to the other practice, rather than ‘borrowing’ and returning replacement stock at a later date. (If stock is borrowed/returned, batch details etc. need to be captured properly where it cannot be lost).
• Further, or different, measures may be required if the shortage continues for longer or if our estimates are a significantly wrong.
• BEVA is working closely with the British Equestrian Federation and the British Horseracing Authority.  These bodies are reviewing their current regulations in light of the vaccine challenge. As of 23 August 2022, the rules and regulations have not been changed, but BEVA will keep members appraised of any developments as and when they are agreed.

Disease Risks:

At the individual horse level, the key risk factors for clinical disease and shedding associated with EI virus are:

1. Competition /mixing of animals from different premises
2. lack of robust vaccine history

BEVA has developed 5 risk bands, outlined in the table below.  The table provides a risk-based framework for common scenarios to help equine vets develop strategies to best protect horses under their care, where there are limitations in available flu vaccine stocks.

Strategies to minimise the use of vaccine doses

1. Vaccinate close to the upper limits for V1-V2 and V2-V3 intervals and subsequent boosters.
2. Consider deferring annual boosters to 15 months in ultra-low and low risk animals.
   • Solid scientific data regarding relaxation of 12-month boosters are lacking. However, limited evidence suggests that a maximum 15-month interval can be safely considered.
   • Where a 15-month extended booster interval is adopted in Autumn 2022, the subsequent vaccine booster interval should be no more than 9 months from the date of the delayed 2022 vaccine (i.e. two boosters in a 24 month period with no requirement for a course restart).
   • This advice was discussed with the VMD and the RCVS on 24th and 25th August 2022.  The VMD have acknowledged that this advice proposes vaccination outside of the SPC / datasheet primary course intervals, booster intervals, and unique vaccine type recommendations; they have suggested that we remind members that the decision to vaccinate in line with BEVA advice, outwith the marketing authorisation, should be based on the clinical judgement of the prescribing vet (which might take into account that the advice is based on input from experts in equine influenza and vaccine mediated immunity) and will require a conversation with the horse owner.
   • The VMD have also recognised that, during this shortage, it may be impossible for each of the primary vaccination doses (V1, V2 & V3) to be of the same vaccine.
   • Where booster vaccination does not occur within 12 months it may be beneficial to annotate the passport flu vaccination record “Booster delayed due to vaccination shortage” plus signature, stamp and date (the future value of this entry is under discussion with the BEF).

Strategies to reduce risk of clinical disease and shedding associated with EIV

1. Enhance biosecurity and surveillance, emphasising that owners should be alert to signs of illness in their horses and not to travel or compete them if signs are noted but rather to seek veterinary attention as quickly as possible.
2. Submit diagnostic samples from horses showing potential signs of flu (fever, cough, nasal discharge)
3. Use the HBLB’s free flu testing scheme
4. Sign up for ICC reports  by sending a request to equinesurveillance@gmail.com and for Tell-Tail text alerts here.
5. Strongly advocate not introducing unvaccinated horses to equine premises
   • If this is unavoidable adopt pre-movement PCR testing, quarantine, and 5-day post-arrival PCR testing.