Embed Size (px)
Citation preview
Shot(s) Happens
The Importance of Vaccines in the 21st
Century
David Levine MD
Pediatrics
Get Ready Folks…
It’s going to be a bumpy ride
Famous last words?
• Who said these things?
A brief history of…
• Germ theory of disease
Written of as far back as ancient Greece
Microorganisms are said to be first directly
observed in the 1670s by Anton van
Leeuwenhoek, an early pioneer in
microbiology (postulated to be the cause of
small pox and other diseases)
The other John Snow
• first published his theory in an 1849 essay On the Mode of
Communication of Cholera, in which he correctly suggested that
the fecal-oral route was the mode of communication, and that
the disease replicated itself in the lower intestines
• Snow's 1849 recommendation that water be "filtered and boiled
before it is used" is one of the first practical applications of germ
theory in the area of public health and is the antecedent to the
modern boil-water advisory
Other important people
• Louis Pasteur
• Robert Koch
A pox on your house!
• Edward Jenner • pioneer of smallpox vaccine, the world's first vaccine. The terms
"vaccine" and "vaccination" are derived from Variolae vaccinae
(smallpox of the cow), the term devised by Jenner to denote
cowpox. He used it in 1798 in the long title of his Inquiry into the
Variolae vaccinae known as the Cow Pox, in which he described
the protective effect of cowpox against smallpox.
• Prior inoculations lead to significant infection with the existing
organism, but Jenner showed it could be done much safer (but
still not as safe as today)
2 Dope Jews
• 1955: Salk, polio vaccine
• 1961: Sabin, oral polio vaccine
• 1962: Vaccine Assistance Act is
passed, leading to creation of the CDC
and mass immunization efforts
And we all lived happily ever after!
Or not…
• 1800’s England (Jenner):
believed that the vaccine was “unchristian” because it came
from an animal
reflected their general distrust in medicine and in Jenner’s
ideas about disease spread
suspicious of the vaccine’s efficacy, some skeptics alleged
that smallpox resulted from decaying matter in the
atmosphere
many people objected to vaccination because they believed
it violated their personal liberty, a tension that worsened as
the government developed mandatory vaccine policies
Snap back to reality…
• With the success of the polio vaccine in
the US, research begins and
development of other vaccines
progresses…
Polio
-attacks motor nerves
-life long paralysis in survivors (FDR)
-death from an inability to breath (iron
lung)
-family anxiety anytime a kid went into a
public swimming pool in the summer
Pop quiz hotshots!
• Which virus is the most contagious:
Flu
HIV
Measles
Small pox
SARS
H1N1 (swine) flu
• Which virus is the most contagious:
Flu (1.3)
HIV (3.5)
Measles (15)
Small pox (6)
SARS (3.5)
H1N1 (swine) flu (1.5)
MMR
• Individual components – 1963-69
• Combo – 1971
• Rampant stupidity - 1998
Measles
• Typical virus with a rash except:
Severe pneumonia
Brain inflammation leading to death or long
term brain damage
Most who die are <5 years old
Mumps
Rubella
• Fairly harmless to any human outside
the womb
Inside the womb, however, can lead to
heart disease, brain damage, death (if the
fetus survives to term)
D-P-T
• Diptheria (5-10% mortality, breathing and
cardiac issues)
• Pertussis (whooping cough, .5% mortality
under age 1)
• Tetanus (10% mortality)
• Individually since the late 40’s
• Current form of DtaP (acellular) - 1991
Diptheria
Tetanus
Hepatitis B
• 1981
• early is the best option: safe and lifetime
protection in most cases
• can still get through casual contact with
caregivers, not just via needles or
sexual contact
HiB
• 1981
• Haemophilus Influenza type B
• Simple – ear infections, sinuses
• Complex – meningitis (hearing loss),
epiglotitis
This is the reason why croup is now treated in
the office and not the ER for most kids
Epiglotitis
Hepatitis A
• 1995
• Food borne
• No chronic infection, but can lead to
acute liver failure
• Most are self limited
Varicella
• 1974 – first vaccine
• Approved in the USA – 1995
• Prior to the introduction of varicella vaccination, the
fatality rates for varicella were approximately 1 per
100,000 cases among children 1-14 years of age, 2.7
per 100,000 cases among persons 15-19 years of
age, and 25.2 per 100,000 cases among adults 30-49
years of age.
• Chicken pox first
• Shingles – 10-20% reactivation later in
life
• Neuralgia and other significant pain
syndromes can occur
Prevnar
• Pneumococcal disease (ear infection,
skin infections, pneumonia, meningitis,
sepsis)
• PCV 7 – 2000
• PCV 13 - 2010
Rotavirus
• Gastrointestinal infection, leading to
severe dehydration and death
• First vaccine – 1998, pulled due to
increased risk of intussusception noted
in POST APPROVAL FOLLOWUP
STUDIES
• New vaccine - 2006
Not deadly in the first world…
Influenza
• Started in 1945
• Antigenic drift (small changes)
• Antigenic shift (large changes)
• Most people, especially kids, that die
every year are not vaccinated
• Not perfect, but you won’t die
Menactra
• 2005
• Meningococcal meningitis, ACYW135
• Death in 2 days
-survival with major morbidity,
including lost limbs, decreased
mental capacity, etc…
HPV
• HPV 4 – 2006
• HPV 9 – 2014
• 80% will get in lifetime
• 50% age 18-59 have it right now (2017)
• High risk strains: 25% males, 20% females
• 31,000 cases of cancer/yr, 4k women die
Meningitis B
• B form, not in menactra
• Not a universal recommendation due to rarity
of disease in the USA, poor immunity
• 2013 – 14 cases, 2 deaths
• 2014 – 8 cases, 2 deaths
• Deaths/yr from lightning strike - 33
• High mortality
So, what’s not to love?
DTP
• Original form of our DTaP vaccine
• 1982 - Articles claiming irreparable
brain damage from vaccine (disproven)
• Possible manufacturing issues lead to
lawsuits and decreased vaccination
• Leads to return of pertussis
• Pharma companies afraid to make
vaccines due to cost of being sued
• 1986: Fed steps in, passing Vaccine
Childhood Injury Act and National
Vaccine Injury Compensation Program
to reduce liability
• No fault, VAERS reporting
• Rise of non-medical exemptions, differ
by state
• “Religious” exemptions
Another Pop Quiz!
• Which socioeconomic group has the
highest rates of non-vaccination in the
USA?
Rich White People
• 1998 – Andrew Wakefield (Lancet,
MMR/autism link)
Retracted 2011 due to fraud, license
revoked
• 2005 – RFK, Jr (Rolling Stone and
Salon, mercury)
Retracted in 2011 due to factual errors
• 2007 – Jenny McCarthy (Oprah)
• NVIC (1982) – from the DTP issue
• Bob Sears – The Vaccine Book
• Joseph Mercola – homeopathy (believes
that HIV does not cause AIDS)
• These people, and many others, say
that they are not anti-vaccine, but pro-
safe vaccines
• As if vaccines are not tested and we
have no idea if they work or not
Still think it is just “good sanitation”?
Other examples
• 2014 – California Measles Outbreak
• 147 cases, 7 states
• 1 pt visited hospital and exposed pregnant
women and babies
• 1 pt on breathing machine for 3 weeks
• 2016 + Measles outbreak in Somali immigrant
community in Minnesota
• 92% rate (2004), 42% rate (2014), 44+ cases
Europe
• 6 nations with endemic measles:
Romania, Belgium, France, Germany, Italy,
Poland
• Poverty, neglect, anti-vaccine rhetoric
stemming from Wakefield
• Herd immunity requires 90-95% rates, these
countries are in the 80’s range
• Germany/Italy (2017) – mandates, fines
Where do you think the Disney outbreak came
from?
HPV
• 31,000 cases cancer/yr
• 4,000 women die/yr
• Yet we cannot stop most of these
because of this
What “they” say…
• Autism (nope, disproven by dozens of studies since
1998)
• Mercury (out of vaccines for over 10 years)
• Aluminum (4mgs in vaccines, 10mgs in breast milk in
first 6 mths – 40 in regular formula, 120 in soy)
• Big $$$ Pharma and docs ($24 billion vaccines vs.
$34 billion for homeopathy, and trillions for everything
else) Most docs lose money on giving vaccines, and some have stopped
The other A word
• Abortion• Fetal cells used to create some vaccines
• 1962 – WI 38 cell line
• 1966 – lung cells from aborted fetus in England
– Obtained from legal abortions, and not done since
– Even the Pope says that the positives of vaccine
outweigh these concerns
But I heard there’s a court!
• Vaccine Court (not public)
5200 claims in 30 years
3 billion (at least) vaccines given in those
30 years
But I heard there’s a court!
• Vaccine Court (not public)
5200 claims in 30 years
3 billion (at least) vaccines given in those
30 years
Safety rate: 99.999984%
But, but, but…
What is the truth?
• They work!
• Nothing is 100%
What can I read?
• The Vaccine Race (Wadman)
• Polio: An American Story (Oshinsky)
• Autism’s False Prophets (Offit)
• Deadly Choices (Offit)
How about online?
• www.skepticalraptor.com
• www.immunize.org
• www.aap.org
• www.ecbt.org (Every Child by 2)
How about on my phone?
• Follow on Twitter:
Tarahelle
Skepticalraptor
Doritmi
Voices4Vaccines
NursesWhoVax
What else can I do?
• Get involved
• Local and state officials, CALL THEM!
• Educate yourself
NJ (2013-2014)
• Unvaccinated by country and age
Essex – PreK 1.9% K 1.3%
Union – PreK 1.3% K 0.8%
Somerset – PreK 3% K 1.5%
Hunterdon – PreK 6.5% K 4.1%
Monmouth – PreK 4.9%K 3.3%
Morris – PreK 3% K 2.1%
• These are YOUR kids, YOUR friends,
YOUR family, YOUR community
• They matter!
Thank You!
