DISCLOSURES: 8/27/18 LEARNING FROM THE PAST: VACCINE CHALLENGES OBJECTIVES: AMERICAN BEGINNINGS ORIGINS-VARIOLATION

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1 DISCLOSURES: Nothing to disclose LEARNING FROM THE PAST: VACCINE CHALLENGES Catherine Lux, DNP, RN, CPNP-PC OBJECTIVES: Discuss the history of modern vaccine development, focusing on the social and physiologic details related to vaccine triumphs and tragedies, and subsequent public response. Trace the concurrent development of the anti-vaccine movement, and the theoretical underpinnings of anti-vaccine sentiment. Examine culturally sensitive ways to address vaccine resistance in practice. Explain the rationale for the AAP Refusal to Vaccinate policy and family statement, and how it can be applied in pediatric practice. The greatest obstacle to knowledge is not ignorance--it is the illusion of knowledge. Daniel Boorstin ORIGINS-VARIOLATION AMERICAN BEGINNINGS Smallpox inoculation Matter from infected sore put into a cut From in oculus to graft a bud India and China from 10 th century Practiced in Ottoman Empire Lady Mary Montague-wife of British Ambassador brought back to Britain Smallpox epidemic 1721 Written up in British Royal Society AD_%DA%A9%DB%8C%D9%88%DA%91%D8%A7.jpg Cotton Mather-Boston minister Learned of practice from Libyan slave Onesimus Read about it in Royal Society Began in 1721 during outbreak Opposition from doctors Opposition from city council Risks of variolation-3% died Variable acceptance in colonies 1

2 JENNER AND VACCINIA PROBLEMS WITH EARLY VACCINATION first documented vaccination: Benjamin Jesty in 1774 Jenner variolation at 8-traumatic First observed that variolation would not produce infection after cowpox. James Phipps-1796 vaccinated, then tested with smallpox vaca=cow Smallpox declared eradicated ween_smallpox_and_cowpox_pustules_on_the_14t_wellc ome_v jpg Medical 3% fatality vs 30% efficacy Contamination-syphilis, sepsis, tetanus Social Poorly enforced quarantine Quacks and medical regimens Forced vaccinations Animal cruelty issues LOUIS PASTEUR DIPTHERIA Provided scientific explanation for vaccines Chicken cholera discovered attenuation Rabies Anthrax granger.html Loeffler-1884-guinea pigs Roux-1894-antiserum Horse antitoxin factories Allergies/anaphylaxis Theobald Smith 1908-toxin-antitoxin miz Origin of Iditarod 1925-Togo and Balto Lead to marketing of many useless bacterins and serum treatments EARLY 20 TH CENTURY POLIO Public faith in science and technology World wars techno-industrial complex and social authority Elevation of status of medical profession Increased life expectancy Heroism of pioneers/martyrs Socio-cultural appropriation of health care Flexner standardizing medical education Public fear Frankiln D Roosevelt March of Dimes Sabin & Salk competition Cutter incident 2

3 MMR AND HILLEMAN LATE 20 TH CENTURY: RAPID EXPANSION 1954-Enders isolates virus 1958 first vaccine-side effects 1963-added gamma globulin Hilleman-1968 Merck Chicken embryos to attenuate Moraten strain Rubella 1969 Mumps MMR Chickenpox 1995 Hib 1985 Hep B 1986 Meningococcus 2005 Rotvirus 2006 HPV 2006 Pneumococcus Prevnar P PCV VACCINE SAFETY CONCERNS DTP CONTROVERSY Ralph Nader 1972-NIH whistleblowers forced switch to FDA ineffective flu vaccines licensing of 75 other ineffective products SV-40 CDC Monitoring System for Adverse Events Following Immunizations Swine Flu fiasco 1976 Ford appropriations bill over 4000 claims, total over $1 million Guillain Barre cases probably from allergic reactions Late1970 s-carter pushed universal vaccination DPT: Vaccine Roulette April 19, 1982, NBC Pertussis component-whole cell Convulsions, brain damage Pediatrics 1948 article-encephalitis Dissatisfied Parents Together Barbara Loe Fischer A Shot in the Dark National Childhood Vaccine Injury Act1986 Vaccine Adverse Event Reporting System (VAERS)-FDA and CDC dpt-roulette. Image credit Lea Thompson, WRC-TV, Washington D.C AUTISM AND MMR Andrew Wakefield Lancet article1998 Lionk between MMR and autism 2004 independent regulator found fatal conflict of interest Wakefield paid by litigators for parents suing vaccine manufacturer 2010 Lancet formally retracted article Wakefield s medical licence revoked in Britain 2011 moves to Austin THE ANTI-VAX MOVEMENT 3

4 SAFETY CONCERNS IMMUNE SYSTEM OVERLOAD Autism Thimerosal-preservative Immunologic adjuvants Aluminum Squalene Local and systemic injury (SIRVA, serum sickness) Live vaccine causing infection (Cutter, Smallpox) Antigenic burden Slow vax vs no vax RELIGIOUS OBJECTION ALTERNATE MEDICAL THEORIES AND SOCIAL CONCERNS Disease is God s will Interfering with nature Only 3 states do not provide exemptions- Mississippi, W. Virginia, California Chiropractic Homeopathy Suspicion over financial motivation Far Right and Far Left Patient and experimental subject rights PARENTAL RIGHTS FEDERAL ANTI-VACCINE EFFORTS Herd immunity Societal burden Political action Facebook activity Mad moms in Minivans Trolls and Malware link 4

5 TEXAS ANTI-VACCINE POLITICS EFFECT IN U.S. EFFECT IN TEXAS STATEMENT I have had the opportunity to discuss the recommendation and my refusal with my child s doctor or nurse I understand the following: The purpose of and the need for the recommended vaccine(s). The risks and benefits of the recommended vaccine(s). That some vaccine-preventable diseases are common in other countries and that my unvaccinated child could easily get one of these diseases while traveling or from a traveler. STATEMENT(CONT D) STATEMENT (CONT D) If my child does not receive the vaccine(s) according to the medically accepted schedule, the consequences may include Contracting the illness the vaccine is designed to prevent (the outcomes of these illnesses may include one or more of the following: certain types of cancer, pneumonia, illness requiring hospitalization, death, brain damage, paralysis, meningitis, seizures, and deafness; other severe and permanent effects from these vaccine-preventable diseases are possible as well). Transmitting the disease to others (including those too young to be vaccinated or those with immune problems), possibly requiring my child to stay out of child care or school and requiring someone to miss work to stay home with my child during disease outbreaks. 5

6 STATEMENT(CONT D) STATEMENT(CONT D) I know that failure to follow the recommendations about vaccination may endanger the health or life of my child and others with whom my child might come into contact. I therefore agree to tell all health care professionals in all settings what vaccines my child has not received because he or she may need to be isolated or may require immediate medical evaluation and tests that might not be necessary if my child had been vaccinated. I know that I may readdress this issue with my child s doctor or nurse at any time and that I may change my mind and accept vaccination for my child any time in the future. QUESTIONS? 6