"Vaccines, measles and myths"- 2015 James Todd, MD.
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Transcript of "Vaccines, measles and myths"- 2015 James Todd, MD.
"Vaccines, measles and myths"- 2015 James Todd, MD
Disclosures
I have no financial interests relevant to this topic...
…but
The State of Colorado and its parents could save a lot of $$$ and further reduce the morbidity and mortality of Vaccine-preventable Diseases if more of their children
were completely vaccinated.
Objectives
Learn that Colorado data confirms vaccine safety and efficacy.
Debunk the myths related to vaccine safety.
Explore the limits of herd immunity.
Explore what can you do to improve vaccination rates in Colorado?
AAP 2015 Vaccination Schedule
It’s complicated!
Where are we? Colorado has made some progress but can’t seem to get above 80%!
45th out of 50 states Differences
between ranks not always significant
Only 72% fully vaccinated by 3 yrs.
Why are immunization coverage levels low in some communities?
Multiple Reasons Poverty Disparities in access Fear of being identified by the
government Risk-benefit misperceptions
How Did We Get Here?• Vaccines as victims of their own success
• Loss of diseases’ visibility.• Loss of a sense of urgency.• Lack of fear
• The assault on science• Facts and evidence are seen as just a matter of
opinion, rather than proven truth• Simple ‘belief’ is often considered as valid as
critical thinking
Hypothetical Pros and Cons of VaccinationPros
Protects children from:DeathHospitalizationComplicationsPain and suffering
Protects others from:All of the aboveLoss of workCosts of care
ConsVaccines don’t work
Lots of shotsToo many antigens
Major adverse eventsAutismBrain damageTransmit HIV
Costs of prevention
Vaccines work in Colorado
There is a strong health and business case for vaccination in Colorado
Vaccines are effective and safe in Colorado
Number of CasesHospital Charge
EstimateColorado Hospitalized Vaccine Adverse Event (any diagnosis code) 3* $29,938Colorado Hospitalized Vaccine Preventable Diseases (Table 1) 538 $29,208,885*Primary or secondary diagnosis codes: 978x, 979x, E948x, E949x (see Methods), actual hospital charges reported.
Table 3: Annual case and charge estimates for vaccine preventable disease and vaccine-related adverse event hospitalizations among Colorado children 0-19 years of age in 2013
Parental Refusal of Varicella Vaccination and theAssociated Risk of Varicella Infection in Children
“Children of parents who refused varicella immunizations were at a greatly increased risk of varicella infection requiring medical care (odds ratio, 8.6; 95% confidence interval, 2.2-33.3) compared with children of parents who accepted vaccinations (P=.004).”
Arch Pediatr Adolesc Med. 2010;164(1):66-70
Pertussis in Colorado156 laboratory-confirmed pertussis cases and 595
matched controls. 18 (12%) pertussis vaccine refusers among the cases 3 (0.5%) pertussis vaccine refusers among the controls.
Children of parents who refused pertussis immunizations were at an 24x increased risk for pertussis compared with children of parents who accepted vaccinations.
Glanz, Jason M.; McClure, David L.; Magid, David J.; Daley, Matthew F.; France, Eric K.; Salmon, Daniel A.; Hambidge, Simon J. (2009): Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children. In Pediatrics 123 (6), pp. 1446–1451
Pertussis – Not just Boulder!
Risks: Many self-perpetuating myths
Pertussis vaccine causes encephalopathy.Measles vaccine causes autism.Thimerosal causes autism/brain damage.Aluminum causes autism/brain damage.Vaccines don’t work.Vaccines aren’t safe.Big government/corporate/physician conspiracy.Too many antigens at once overwhelm the infant’s
immune system.Vaccines cause AIDS.
Wakefield, A.J., et al. Lancet 351: 637-641, 1998.
MMR-Autism: Scientific Studies
Taylor, B, et al. Lancet 1999;351:2026-29 Dales L, et al. JAMA 2001;285:1183-85 Kaye JA, et al. Brit Med J 2001;322:460- Madsen KM, et al. N Engl J Med 2002;347:1477-82 Peltola H, et al. Lancet 1998;351:1327-8. Makela A, et al. Pediatrics 2002;110:957-63 DeStefano R, et al. Pediatrics 2004;113:259-66 Farrington CP, et al. Vaccine 2001;19:3632-5 Fombonne E, et al. Pediatrics 2001;108:e58 Taylor, B, et al. British Med J 2002;324:393-6
Thimerosal
Many pseudo-scientific hypotheses came after this, the most common being that children with autism metabolize mercury differently and therefore are more prone to its effects.
The evidence: there is no scientific evidence to support this hypothesis, and many studies refuting it.
Court panel of special masters: “…the evidence advanced by the petitioners has fallen far short” of showing a link between thimerosal and autism.
So what about aluminum? Found in numerous foods and beverages, baby
formulas, honey Typical adults ingest 7-9 milligrams of aluminum per day
Aluminum contained in vaccines is similar to that found in a liter of infant formula
Infants receive about 4.4 milligrams of aluminum in the 1st six mths of life from vaccines
Breastfed infants ingest about 7 milligrams Formula-fed infants ingest about 38 milligrams Soy fed infants ingest about 117 milligrams
Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System?
Infant has theoretical capacity to respond to about 10,000 vaccines at any one time! (107 B cells per mL by 103 epitopes per vaccine)
Most vaccines contain fewer than 100 antigens, therefore if 11 vaccines given at one time then 0.1% of the immune system would be “used up”
Children are Exposed to Fewer Antigens Than in the Past
Actual Pros and Cons of VaccinationPros
Protects children from:DeathHospitalizationComplicationsPain and suffering
Protects others from:All of the aboveLoss of workCosts of care
ConsVaccines don’t work
Lots of shotsToo many antigens
Major adverse eventsAutismBrain damageTransmit HIV
Costs of prevention
Herd Immunity
What is the herd immunity threshold?Does Colorado meet it?
86%
81%
Colorado 2013: 19-35mth
85%? 88-90%
Young Colorado children are under the herd immunity threshold
Page 27
0 3 5 7 13 19 240
10
20
30
40
50
60
70
80
90
100
Figure 8: Colorado Vaccination Compliance from Birth to 24 Months of Age, 2010
DTaP
MMR
VAR
AGE in Months
% C
ompl
ete
Measles PertussisVaricella
The Problem of the mini-Herd
Colorado’s Children
Immune Not immune Not immune, exposed, disease
Mini-Herd
Uncommon external exposure
Common internal
exposure
Mini-Herd Dynamics
Congregate togetherDay CarePlay Dates
Common vaccine philosophyAlternative schedulesDelay in (spacing) vaccinationBiased view of vaccine risk and VPD severity
Frequent Travel – external exposure
Alternative health care beliefsDelay in diagnosis/treatment/secondary prophylaxis
Colorado is below 90% compliance for most individual vaccines
0
10
20
30
40
50
60
70
80
90
100
Perc
ent V
acci
nate
d
Year
Figure 3: NIS Vaccination Percentage, 19-35 months: Colorado, 1995-2010
DTaP4 Polio3MMR1 HIB3HepB3 Varicella1Pneumococcus4
Non-compliance gaps suggest alternative schedule effect
• Significant vaccination gaps in youngest children
• Influenza vaccine gap probably higher
Youngest children are at the highest risk!
Vaccination Goals for ColoradoImprove and expand CIIS:
Better measure current ratesMeasure by region
Improve access to primary care and vaccinationImprove vaccination pro/con education of all parentsMaximize on-time vaccination of all children
Especially very young childrenInfluenza! Reduce costs & minor morbidity of vaccination
Minimize PBEDay care and school reporting of rates (? Adults too)Market “protect your kids”
Market: Safety, Efficacy & Exposure Risk
What About Colorado’s Personal Belief Exemption Law?
Most Exemptions in Colorado are PBE
PBE – Much easier than vaccinating
VOID
Resourceshttp://www.immunizeforgood.com/http://www2.aap.org/immunization/pediatricians/pdf/
TopStrategiesforIncreasingCoverage.pdfhttp://www2.aap.org/immunization/pediatricians/
communicating.html http://www.cdc.gov/vaccines/hcp/patient-ed/conversatio
ns/index.html
http://pediatrics.aappublications.org/content/127/Supplement_1/S127.full.html
http://www.thecommunityguide.org/vaccines/index.html
Questions?
40
For pre-kindergarten children attending a licensed child care facility, non-medical immunization exemption forms will be submitted following each age immunizations are recommended on the schedule developed by the Advisory Committee on Immunization Practices (ACIP).
For students attending kindergarten through 12th grade, non-medical immunization exemption forms will be submitted during annual enrollment/registration.
Schools with children birth through 12th grade will be required to annually report aggregate immunization and exemption information to CDPHE via an online form by December 1 of each year.
CDPHE will publish school and child care immunization rates annually.
Additionally, the proposal adds rules regarding the contents of an online learning module to meet the requirements of House Bill 14-1288.
BOH Immunization Exemption Rule Changes
http://sierrasraceagainstmeningitis.com/
Sierra’s Race Against Meningitis