Worldwide vaccine uptake-2014

vaccines-saves-live-cloud

I make it a point to update this blog with the most current CDC analysis of vaccine uptake in the USA for kindergarten children (usually around 5 years old). Generally, the numbers have stayed stable, at around 95% vaccinated, although there is high variance from state to state, and locality to locality. The weakness in the vaccination uptake in the USA is that some areas may approach 100% vaccinated, but then other areas may be 50%, which makes those areas with low vaccine uptake susceptible to a quick spread of diseases that are not endemic to the USA (such as measles, polio, and others) through that unvaccinated population.

Given the 95% vaccine uptake rate, it begs the questions of why I push so hard for vaccination–because I want to protect the lives of children, and those 5% who aren’t vaccinated are at risk of serious disease and even death. And vaccines are the safest way to protect a child–protect them from death.

Nearly 55% of the readers of this blog are not American (a couple of years ago,this blog got a regular reader from Iran, which meant that all countries were represented amongst this blog’s readers). I have been accused of being a bit American-centric, but at the same time, I was also curious about vaccine uptake worldwide.  Continue reading “Worldwide vaccine uptake-2014”

Why we vaccinate–so mom will protect her newborn baby

tdap-mother-pertussisOne of the important hypotheses of vaccination is to make sure that all family members or others who may encounter a newborn child be vaccinated, especially since many vaccinations are not indicated for infants for a couple of months after birth–those newborns are very susceptible to vaccine preventable diseases until they themselves are vaccinated with the DTaP vaccine (which also protects against tetanus and diphtheria).

This protective “cocoon,” especially important with whooping cough (Bordetella pertussis), theoretically blocks the transmission of the disease to a newborn by creating a protective circle of vaccinated individuals around the newborn. A teenage sibling could catch the disease and accidentally infect the infant. Pertussis is bad enough for a teenager, but it can be deadly to a baby.

Even though the evidence for cocooning is growing, there are some flaws to the idea that are still being investigated in various parts of the world. One of the concerns is that asymptomatic carriers of pertussis (who have been vaccinated) might transmit the disease through a cocoon. However, scientists have known that the current version of pertussis vaccine, called acellular pertussis, isn’t as effective as it should be, but it is still better than not vaccinating. Much better. But that is a potential hole in the protective cocoon that needs to be understood better through research. Continue reading “Why we vaccinate–so mom will protect her newborn baby”

Why we vaccinate–because pertussis kills babies

The California Department of Public Health (CDPH) recently announced that the number of whooping cough (Bordetella pertussis) cases through May 2014 has already exceeded the number in 2013. As of 27 May 2014, the CDPH reported 2,649 cases of pertussis since the beginning of the year. More concerning, there were 800 cases reported in April alone, the highest monthly number since California’s 2010 whooping cough epidemic.

whooping-cough-vaccinated

Whooping cough can be easily prevented by the DTaP or Tdap vaccines (which also protect against tetanus and diphtheria), which can be given to infants as early as 6 weeks to 2 months old.

According to the CDPH, infants who are too young to be fully immunized or those who are not vaccinated are most vulnerable to severe and fatal cases of pertussis. In 2014, 66 of the pertussis hospitalizations cases were children four months of age or younger. Two infants have died of pertussis in California this year.

Of the 2,649 cases so far this year, 83% have occurred in infants and children younger than 18 years of age. Of these children, 8% were younger than 6 months old, and 70% were 7 through 16 years of age. In other words, all children are susceptible to the disease.

The CDPH breakdown by county (pdf) shows a stark and troubling trend:

  • Sonoma County–83.28 (incidence rate per 100,000 residents)
  • Napa County–42.42
  • Marin County–38.30
  • Tehama County–37.83
  • Trinity County–22.32
  • Humboldt County–19.29
  • City of Berkeley–18.24

TDaP-vaccine-vialFor those of you who do not live in California, these are some of the wealthiest, most educated counties in the country, let alone California. Marin County is one of the whitest, wealthiest (a median income over US$113,000), best educated, and most liberal (nearly 75% of the county voted for Barack Obama). Sonoma, Napa, Trinity, Humboldt and Tehama counties, along with the City of Berkeley, are very similar in socioeconomic makeup.

These constitute probably the largest pockets of vaccine denialism, which is demonstrated by the unusually high incidence of pertussis versus the statewide incidence rate of the disease of 6.93. This provides me, at least, with additional evidence that liberals can be as anti-science as right wing fools. Vaccines are safe. Vaccines prevent diseases like pertussis which can kill children. I’m not sure why the parents in these areas miss these basic points, But these pockets of hostility towards vaccines will be ground zero for any future epidemic in other diseases like measles or chickenpox.

As a reminder, the CDPH makes these recommendations about vaccinating against pertussis:

  • Pregnant women receive a pertussis vaccine booster during the third trimester of each pregnancy, even if they’ve received it before.
  • Infants be vaccinated against pertussis as soon as possible. The first dose is recommended at two months of age but can be given as early as 6 weeks of age during pertussis outbreaks. Children need five doses of pertussis vaccine by kindergarten (ages 4-6).
  • California 7th grade students receive the pertussis vaccine booster as required by state law.
  • Adults receive a one-time pertussis vaccine booster, especially if they are in contact with infants or if they are health care workers who may have contact with infants or pregnant women.

These are very similar to CDC recommendations regarding the vaccine.

These two babies would not have died, if they had been vaccinated (along with anyone in close contact) against whooping cough. A simple, effective, extremely safe vaccine. Are parents’ ignorance of scientific facts an excuse for these dead babies? Not in my world, where protecting children from harm should be a primary goal of society.

 

Visit the Science-based Vaccine Search Engine.

Inventing your own vaccine schedule? Not a wise idea.

There antivaccination crowd runs the gamut from truly scary deniers who invent all sorts of lies to try to stop vaccines to people who seem to think that the risk of vaccine adverse events somehow surpasses the risk of the disease itself, mostly because they lack the cultural memory of what it was like in the world pre-vaccines. Vaccines are a critical part of the drop in the infant mortality rate by over 90% since the 1930’s, so we have just forgotten.

There is a group of parents that kind of sit in the middle of the so-called “vaccine debate.” They are not necessarily opposed to vaccinations, but they pick and choose which vaccines they give their children, and they have come up with a revised vaccine schedule which has no basis in science. Dr. Sears (there’s four of them in the family, and they all say the same thing) is one of the more notable proponents of the revised vaccination schedule.  In general, the vaccine delayers avoid some vaccines (Hepatitis-B being the most important one), and delay or even eliminate boosters shots.

vaccine-schedule-CDC-alternative

The current US-based vaccine schedule is established by some pretty bright people. The Advisory Committee of Immunization Practices, a part of the US Centers for Disease Control and Prevention, the world’s leading center for detecting and preventing infectious diseases, is made up of some of the nation’s leading experts on infectious disease, immunology, vaccines, and public health. Their only goal is to determine which vaccines are necessary to protect the lives of citizens of the USA, and then to establish a healthy schedule for those vaccines. They do not pull this data out of thin air, but is based on the best research evidence available to them. As I’ve written before, vaccines prevent over 42,000 deaths every single year.

A recent study found that delaying the MMR vaccine (for measles, mumps and rubella), in the second year of life, doubled the risk of a seizure occurring after the vaccination. Now seizures are not unusual with vaccination, and are a result of the high fever that some children get after vaccination. But seizures are fairly common in children who haven’t been vaccinated recently. It’s always scary to parents, but they are minor, usually cause no long-term damage, including epilepsy.

The researchers, led by Simon Hambidge, MD PhD, of the Institute for Health Research at Kaiser Permanente Colorado, analyzed data from 323,247 children, born between 2004 and 2008, whose records are in the Vaccine Safety Datalink system, a collaborative effort between CDC’s Immunization Safety Office and 9 managed care organizations (MCOs), that monitors immunization safety and address the gaps in scientific knowledge about rare and serious events following immunization

The researchers located records 5,667 children who had experienced a seizure in their first two years of life and did not have a seizure disorder. The researchers then compared the timing of these children’s seizures to the dates they had received various vaccinations and considered whether the vaccines had been received on time or not, per the CDC’s and ACIP’s recommendations

cdc-vaccine-scheduleThe analysis revealed that there was no correlation between receiving any vaccine and experiencing seizures for children during their first year of life. However, those children who received the MMR vaccine between 12 and 15 months old, when it’s recommended, were at about 2.6X higher risk of a seizure than an unvaccinated child. That translates to about one seizure for every 4000 children receiving the vaccine. If parents delayed the MMR vaccine until any time between 16 and 23 months, the risk of a seizure was 6.5X greater than when not being vaccinated. In other words, delaying the vaccine 4-8 months more than doubles the risk of seizures.

In general, febrile or acute seizures are not serious, they just seem scary. Most vaccines, such as  DTaP (the vaccine for diphtheriatetanus and whooping cough) actually show no difference in seizures between vaccinated and unvaccinated children. Seizures occur in about 5 out of 100 children sometime during their lives, with 95% of them not serious or symptomatic of other diseases. In other words, the background risk of seizure might actually be higher than the incidence observed in vaccinated children, just in case a reader wants to head down that path.

Thus, if you’re coming up with your own vaccine schedule, you’re increasing the risk of a minor, but kind of scary, adverse event–a febrile seizure. Why would one do that to gain no other benefit? That’s not clear to me.

Visit the Science-based Vaccine Search Engine.

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Refuting another antivaccination lie about the pertussis vaccine

Here we go again. There have been some articles published in peer-reviewed journals which have caused the antivaccination cult to not only misinterpret the data (shocking), but then broadcasting another lie (more shocking) which could lead to lower vaccinations rates.

Smart baboons searching for the pertussis vaccine.
Smart baboons searching for the pertussis vaccine.

According to research, some individuals who have been vaccinated against whooping cough (Bordetella pertussis), with either the DTaP or Tdap vaccine (which also protect against tetanus and diphtheria), remain infected with the pertussis bacteria, although they are asymptomatic. This is been morphed into the internet meme that only those who have been vaccinated carry the disease. Or worse yet, that the vaccine causes the asymptomatic infection. Typical of pseudoscience, the vaccine deniers take a little bit of scientific fact, and mutate it into something that meets their own biases.

First, let me give you a bit of background about the disease and vaccine, so that you can have a bit more context on what we’re discussing. The original DTP vaccine, sometimes called DTwP, became available in the USA in 1948 and was critical to dropping the number of cases of whooping cough from 260,000  in 1934 to less than a few thousand per year in the 1990′s. The original vaccine contained what was called “whole-cell” pertussis (thus wP), which includes all of the antigens of the pertussis bacterium, partially because it wasn’t understood (and to some extent still not fully understood) which antigens on the bacteria actually induce the proper adaptive immune response to destroy a pertussis infection. Continue reading “Refuting another antivaccination lie about the pertussis vaccine”

Pertussis vaccine reduced length and severity of whooping cough

Except for the evidence that says it's not a failure.
Except for the evidence that says it’s not a failure.

I know, there are just so many tropes and outright lies pushed by the vaccine deniers, it’s really hard for this writer to keep up with it all. But there’s one that has always bothered me, but I didn’t have quite enough evidence to lustfully debunk in my usual manner.

As has been shown in few studies, the vaccine against whooping cough (Bordetella pertussis), either  DTaP or Tdap (which also protect against tetanus and diphtheria), isn’t as effective in providing long-term protection as our expectations, based on other vaccines. Although the antivaccination cult has misinterpreted and misstated the actual numbers, an analysis of the data from the Washington State pertussis epidemic in 2011-2012 provided us with the following information:

  • Ages 5-9 unvaccinated or under vaccinated children are 6 times more likely to become infected with pertussis than fully vaccinated. 
  • Ages 10-13 unvaccinated or under vaccinated are 25 times more likely to become infected with pertussis than fully vaccinated. 
  • Ages 14-18 unvaccinated or under vaccinated  are 6 times more likely to become infected with pertussis than fully vaccinated.

In other words, not getting the vaccine made it easier to get infected with whooping cough. Continue reading “Pertussis vaccine reduced length and severity of whooping cough”

Effectiveness of pertussis vaccines–science vs. lies

Infographic about whooping cough risks for babies.
Infographic about whooping cough risks for babies.

Update of an article published on 7 September 2012.

Over the past few months I have written extensively about several whooping cough (Bordetella pertussis) outbreaks which had reached epidemic levels in areas like the Washington state, and has been considered one of the worst outbreaks in the USA during the past several decades. The outbreak has lead to several deaths here in the USA and in other countries such as the UK. Of course, these outbreaks and epidemics have lead to the “blame game” from the antivaccination gang, because they have claimed that since A) most kids are vaccinated, and B) we’re having this outbreak then C) either the vaccines are useless or are actually the cause of the outbreak. Seriously. They blame the vaccines.

So I decided to search the internet to find the most popular vaccine denialist arguments regarding pertussis vaccinations, and deconstruct and debunk them. Hopefully, it will be a useful tool for you when you’re engaging a ridiculous argument with one of those antivaccinationists. Of course, I could use the information too. Continue reading “Effectiveness of pertussis vaccines–science vs. lies”

Why we vaccinate–protecting babies from pertussis

tdap-vaccineRecently, there have been several outbreaks of whooping cough (Bordetella pertussis), including one that reached epidemic levels in Washington state, which has been considered one of the worst pertussis outbreaks in the USA during the past several decades. The disease lead to 18 infant deaths in the USA during 2012.

The Advisory Committee on Immunization Practices (ACIP) recommends (pdf) that children should get 5 doses of DTaP (the vaccine for (diphtheriatetanus and pertussis), one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. Those children who are not completely vaccinated according to these ACIP recommendations for pertussis are considered to be “undervaccinated.”  Continue reading “Why we vaccinate–protecting babies from pertussis”

Vaccine exemptions contribute to outbreaks of preventable diseases

vaccines-religious-exemptionOnce again, a new study is published in a peer reviewed journal that shows that exemptions to proper and recommended levels of vaccination for children before entering public school are harming the general population. I’ve talked about the issue of exemptions causing outbreaks or epidemics previously in New York, Washington, and other places

Over the past few years, there have been several outbreaks of whooping cough (Bordetella pertussis), including one that reached over 9000 individuals in California in 2010, considered one of the worst pertussis outbreaks in the USA during the past several decades

The original DTP vaccine (diphtheriatetanus and pertussis) became available in the USA in 1948 and was critical to dropping the number of cases of whooping cough from 260,000  in 1934 to less than a few thousand per year in the 1990′s. The Advisory Committee on Immunization Practices (ACIP) recommends (pdf) that children should get 5 doses of DTaP (the replacement for the original DTP vaccine), one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. Those children who are not completely vaccinated according to these ACIP recommendations for pertussis are considered to be “undervaccinated.” 

Whooping cough is a serious disease that has significant complications for children:

  • 1 in 4 (23%) get pneumonia (lung infection)
  • 1 or 2 in 100 (1.6%) will have convulsions (violent, uncontrolled shaking)
  • Two thirds (67%) will have apnea (slowed or stopped breathing)
  • 1 in 300 (0.4%) will have encephalopathy (disease of the brain)
  • 1 or 2 in 100 (1.6%) will die. In 2012, pertussis killed 18 infants in the USA.

Even in adults, there are substantial complications from whooping cough, such as broken ribs from coughing, that can have a significant impact on the overall health. Continue reading “Vaccine exemptions contribute to outbreaks of preventable diseases”

Cocooning the family to protect infants from whooping cough

Infant being treated for pertussis infection. ©CDC, 2012.

Over the past year or so, there have been several outbreaks of whooping cough (Bordetella pertussis), including one that reached epidemic levels in Washington state, which has been considered one of the worst pertussis outbreaks in the USA during the past several decades. The disease lead to 18 infant deaths in the USA during 2012.

The original DTP vaccine (diphtheriatetanus and pertussis) became available in the USA in 1948 and was critical to dropping the number of cases of whooping cough from 260,000  in 1934 to less than a few thousand per year in the 1990′s. The Advisory Committee on Immunization Practices (ACIP) recommends (pdf) that children should get 5 doses of DTaP (the replacement for the original DTP vaccine), one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. Those children who are not completely vaccinated according to these ACIP recommendations for pertussis are considered to be “undervaccinated.” 

Whooping cough is a serious disease that has significant complications for children:

  • 1 in 4 (23%) get pneumonia (lung infection)
  • 1 or 2 in 100 (1.6%) will have convulsions (violent, uncontrolled shaking)
  • Two thirds (67%) will have apnea (slowed or stopped breathing)
  • 1 in 300 (0.4%) will have encephalopathy (disease of the brain)
  • 1 or 2 in 100 (1.6%) will die

Even in adults, there are substantial complications, such as broken ribs from coughing, that can have a significant impact on the overall health of the individual.

One of larger concerns with recent outbreaks of pertussis has been that adults with lapsed immunity or unvaccinated older children may pick up the infection, then pass it to these unvaccinated or partially vaccinated infants (usually less than 1 year old). 

Continue reading “Cocooning the family to protect infants from whooping cough”