Vaccination

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In regards to public health, survival, and longevity we would be hard pressed to not consider modern vaccination as one of the top 2 or 3 developments in the history of mankind.

The History of Vaccine Development and Implementation

If you like history and science then you will be inspired by the story of Jonas Salk and the development of the flu vaccine and later the Polio vaccine.

Enjoy the book: Splendid Solution: Jonas Salk and the Conquest of Polio

 

Prior to effective vaccines:

Diphtheria killed 10,000 people per year in the 1920’s.

Polio afflicted 50,000 children per summer in 1940’s-50’s

Measles infected 500,000 people per year in U.S.

1918 Spanish flu killed up to 50 million people worldwide.

1957 70,000 deaths in the U.S. from H2N2 Asian flu

1964 Rubella kills thousands of children in the U.S.

Key events in history of vaccine development:

1796, Europe, Edward Jenner experimented with inoculation with cattle version of smallpox and then learned it protected against Smallpox.  This was the birth of the vaccine era.

100 years past, 1877 Pasteur formulated the germ theory and did experiments with weakened germs to prevent rabies.  He developed inactivated rabies vaccine in 1884.

By mid century Jonas Salk and Albert Sabin developed the Polio vaccines still used today to rid the civilized world of polio.

Timeline of vaccine development:

1914 Rabies and Typhoid vaccines licensed in the U.S.

1915 Pertussis vaccine was introduced.

1930 Scientists learned to culture viruses in labs, paving way for vaccines for viruses.

1938 FDR founds the March of Dimes to develop treatment and prevention strategies for polio.

1942 Influenza A/B was developed by the Armed Forces Epidemiological Board, Jonas Salk.

1945 Inactivated flu virus licensed in the U.S., Jonas Salk

1947 DTaP was licensed in U.S. for children

1949 Last case of smallpox in the U.S., another 20 years before disease was irradiated in world.

1952 57,628 cases of polio in the U.S.

1955 Inactivated polio vaccine licensed in U.S., Jonas Salk

1961 Oral Polio vaccine was licensed by Sabin.

1962 JFK signs mass immunization assistance program

1963 First live virus Measles vaccine was developed.

1966 National Measles campaign decreases incidence to 10% of pre vaccine era.

1967 global smallpox eradication campaign

1971 U.S. stops Smallpox vaccine program

1973 Measles and Mumps vaccine licensed.

1974 Meningococcal vaccine licensed

1977 Pneumococcal vaccine developed for 14 strains of the 88 known to cause disease.

1977-Small Pox was eradicated from the world.

1979 las case of wild polio in U.S., unvaccinated religious group.

1981 first hepatitis B vaccine

1985 HiB vaccine for meningitis licensed.

1991 last case of polio in western hemisphere

1995 first childhood immunization schedule was developed by AAP, AAFP

1995 hepatitis A vaccine licensed.

1998 Rotavirus vaccine licensed.

2006 Zostavax for Shingles was licensed.

2009 Gardisil licensed to prevent genital warts and cervical cancer, nearly 100% effective for cancer prevention.

2010 Gates Foundation pledges $10B for Vaccine Decade.

How Vaccines Work

When we become infected with live germs our immune system reacts using B cells, T cells and Macrophages.  As a result of the reaction the invading germs can be killed or contained and our body retains memory T cells to immediately fight the same or similar germs in the future.  This whole process of fighting a new infection can take several weeks for the immunity to ramp a response, it is during this time that susceptible victims may die or need antimicrobial medications to assist their body in curing the illness.

Vaccines are made of weakened germs, or fragments of germs, or killed germs to induce our immunity.  As the body’s immune system reacts to the germ like particles in the vaccine, antibodies are created.  These antibodies then provide subsequent protection for months or years or even a life time.  If a our body is exposed to a live germ, for which we have received immunization, then our memory T Cells and B cells and antibodies are loaded and ready to react to the live germs and the host may have a more minor illness or not even become ill at all.

There are several types of vaccines depending on the germs being targeted.  Some have live but weakened viruses, like MMR and Varicella.  Some vaccines have only killed germ fragments and some cause immunity to toxins that germs produce inside a victim.  Often, many doses and boosters are necessary to provide adequate immunity in a recipient of the vaccine.

Link to the CDC: How Vaccines Work

Vaccine Recommendations and Schedules

Summary:

9 child and adolescent vaccines to be given

Annual flu shots

DTaP every 10 years

Shingles shot at age 50-60

Pneumonia shots (2) at age 65, or earlier for special populations

Travel Vaccines for special circumstances: Yellow Fever, Rabies, Typhoid, hepatitis and Malaria antibiotics.

Resources:

Travel Vaccine: http://wwwnc.cdc.gov/travel/destinations/listResources:

CDC Vaccines and Immunizations: http://www.cdc.gov/vaccines/recs/immuniz-records.htm

Vaccine Controversies

Vaccines can absolutely be revolutionary and dramatic in their affects on human disease.  A successful vaccination program can literally eliminate or dramatically diminish the incidence of an infectious disease in a society.  I have seen the virtual elimination of several disease just in my career due to the development and deployment of vaccination.  In medical school, while doing pediatrics rotation, we had a child with Haemophilus meningitis.  Our teacher told us, you won’t see that anymore, there is a new vaccine being implemented to eliminate it.  He was right, I’ve never seen, nor heard of a patient with this deadly disease in my career.  I’ve seen Rotavirus go from being one of our most common pediatric admitting diagnosis to now being virtually unheard of.  I’ve had a few patients with post polio syndrome, and will never see another new case in my lifetime.

That doesn’t mean that side effects don’t occur.  I’ve seen a healthy adult get a rare side effect called Guillain Barre Syndrome from flu vaccine.  We had given him vaccine one day, the next day he had trouble walking into my office, I saw him outside my window.  That night in the hospital after many normal tests and scans to rule out stroke and tumors and ruptured discs I knew he had GBS.  We had to transport him to UNMC for lifesaving plasmaphoresis.  He needed months of rehab to recover.  Gillian Beret is more common with an actual live case of influenza than it is with vaccine.

Researchers have falsified data and performed retrospective pseudoscientific and unsound investigations into a link between vaccine and Autism.  They have been discredited and have personally profited as professional witnesses and proponents of chelation therapies that they developed and profited from.  No properly done scientific investigation has shown a link between vaccine and Autism.  This fear mongering is blamed for scaring thousands of parents into denying MMR vaccine to their children resulting in more that 10,000 deaths from Measles in the world.  The incident has been called the “most damaging medical hoax in the last 100 years.”  The preservative has since been removed from the MMR vaccine, but is used in trace amounts in flu shots.

link to Thiomersal controversy:

Thiomersal controversy

Vaccination and the Law

State Laws

State laws establish vaccination requirements for school children. These laws often apply not only to children attending public schools but also to those attending private schools and day care facilities. All states provide medical exemptions, and some state laws also offer exemptions for religious and/or philosophical reasons. State laws also establish mechanisms for enforcement of school vaccination requirements and exemptions.-CDC website

Nebraska vaccine requirements

Vaccine Laws in Nebraska

 

 Vaccine Costs

 

A rough calculation of the cost of vaccine and administration.

Ages 2,4,6 months: $490 per visit

Ages 12,15 mos.: $350 total, another $90 at age 2 for hep A.

Kindergarten shots: $290

plus annual flu: 60/year=$720

7th-12th grade: 20+177×3+112×2, plus annual flu ($60)=$1195

Total cost to immunize through age 18 = $4115 

Note: almost all costs are covered by insurance with no copay or deductible.

Link to vaccine costs

Vaccination Rates

MMR compliance for kindergartner age is 94%.

Adolescents: Meningococcal, HPV and dTaP:

HPV: 36% female, 13% male

dTap: 87%

Meningitis: 79%

Access to Vaccines

VFC

The Vaccines For Children (VFC) program is a federally funded program that provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay. CDC buys vaccines at a discount and distributes them to grantees—i.e., state health departments and certain local and territorial public health agencies—which in turn distribute them at no charge to those private physicians’ offices and public health clinics registered as VFC providers.-CDC

Private Insurance

BCBS website indicated “No charge for preventive services/screening/immunizations.”  Meaning that deductibles and copays should be zero.  Check with your insurance company to confirm.

 

Vaccination for impoverished nations

World Wide

If developing countries vaccination rates could be brought up to 90% compliance it is estimated that 2 million children’s lives could be saved each year.

Bill and Melinda Gates Foundation:

$44B endowment, $27 B from Gates.  Warren Buffet has donated billions of dollars and pledged even more with conditions.

$10B has been spent or pledged to vaccinate the world.

Conclusions:

God has blessed mankind with many remarkable scientists and doctors throughout our history.  Please take advantage of the incredible blessing of vaccination for yourself and your family.  Vaccines are incredibly safe, relatively cheap, and very effective at preventing devastating diseases that plagued our ancestors.  There is no more natural way to prevent infectious diseases than to use vaccines to educate your bodies natural immune system to help keep you and your family healthy.

References:

WHO

CDC