VACCINES FOR THE COMMON GOOD

Transcription

1 VACCINES FOR THE COMMON GOOD Sharon McMullen, RN, BSN, BA

2 Outline 2 Vaccines, RIPI Exemptions Antivaccinationist vs Vaccine Hesitant Risk Communication Vaccine Myths Debunked Conclusion, Discussion, Resources

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7 7 In the US, policy interventions, such as immunization requirements for school entry, have contributed to high vaccine coverage and record or near-record lows in the levels of vaccine-preventable diseases. Omer et al. Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases, N Engl J Med. 2009;360:19.

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10 3 Types of Exemptions Medical 2. Religious 3. Philosophical/ Personal Belief

11 Ease of process Philosophical/Personal Belief 11 the Path of Least Resistance? Proportion of exemptions Rota, J et al. Processes for Obtaining Nonmedical Exemptions to State Immunization Laws. Am J Public Health. 2001;91:

12 Percent of Students 2.5% 2.0% Medical (ME) and Personal Beliefs (PBE) Exemptions Among Kindergarten Students, California % 1.0% 0.5% 0.0% Source: Lee, T. California Dept. of Public Health, Imm. Branch. NIC Vaccination Status of California Personal Belief Exemptors

13 Herd Immunity: When more people are resistant to a disease, less of that disease will circulate 13

14 Measles, United States, 2011 Geographic Distribution of Cases (n=222) = 1 case MMWR. Measles United States, 2011 April 20, 2012 / 61(15);

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16 16 Kumar, A., Murray, D., Havlichek, D. Immunizations for the College Student: a campus perspective of an Outbreak and National and International Considerations, Pediatr Clin North Am.

17 ACHA Guidelines Recommendations for Institutional Prematriculation Immunizations 17

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19 19 The anti-vaccine movement

20 How do Americans feel about vaccines? 20 Vaccine Acceptors Antivaccinationist 1-3% Vaccine Hesitant Largent, M. The Modern American Vaccine Debate, Academy of Natural Sciences, 4/24/12

21 Myths and Misperceptions 21 -why should we bother to counter them?

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23 Yudell, M. Risk Communication, Ethics, And Public Health: Challenges And Opportunities Practice in Action Monthly Webinar Series What Is Risk Communication? 23 Providing understandable risk information to enhance the autonomy of individual choices Persuasive messaging to get individuals to accept particular risk-related decisions or policies as correct

24 How to talk to people about their vaccine fears Avoid extremes 2. Acknowledge, counter 3. Contextualize

25 vaccines are 25 Although safe and effective, they are neither perfectly safe nor perfectly effective. Malone, K. M. and Hinman, A. R Vaccination mandates: The public health imperative and individual rights. In Law in public health practice.

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28 28 Varicella and Hep B? Not at the same time. Too many vaccines at once overwhelm the immune system.

29 Reality: 29 The immune system is well-equipped to handle the trillions of immunological components it encounters

30 95% Reduction 30 Childhood Vaccines Immunological Components

31 31 Vaccines don t work. In outbreaks, more vaccinated people get sick than unvaccinated people Define more

32 Measles exposure 99.5% MMR Coverage 5 not vaccinated all get sick 2% of the vaccinated also get sick why? 32

33 33 I ve never met anyone who had measles or mumps or whatever. These diseases don t exist any more. Travel much?

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35 Vaccines don t work disease incidence has declined because of better hygiene and sanitation Indirect vs. Direct Impact 35

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37 Pertussis vaccine s: whole cell DTP 1991: DTaP acellular: far fewer side effects 1997: DTP phased out 2005: Tdap booster licensed 2011: booster recommendations expanded

38 38 My mom says I had a high fever and screamed non-stop for hours after a pertussis vaccine as a baby. My doctor says that means I m allergic to pertussis vaccine.

39 39 Recommendations and Reports December 15, 2006 / 55(RR17);1-33 Conditions NOT Precautions for Tdap Following a Dose of DTaP/DTP: temperature >105 collapse or shock-like state persistent crying lasting > 3 hours convulsions with or without fever

40 40 I m not against vaccines but I don t know who to trust. I just want to make the best decision for my kid.

41 Andrew Wakefield 41 His theory: MMR vaccine causes a bowel disorder ( autistic enterocolitis ) that then causes autism

42 Mar 95: measles -UC patent Timeline Jun 97: measles vax patent Feb 98: Lancet article Feb 96: legal retainer Jul 96: 1 st child enrolled Dec 99: study replica. ordered 42

43 Oct 01: fired Jan 03: 79% MMR coverage in UK Mar 04: 10 coauthors drop Feb 04: research funding revealed Nov 04: vax patent revealed 43

44 Apr 06: 1st measles death May 2010: Wakefield is erased from UK medical register 44 Jul 07: misconduct inquiry Feb 10: Lancet retraction

45 Analysis: 45 Wakefield perpetuated a scheme to launder an idea into the medical literature that lawyers could then use as proof to sue vaccine makers

46 Wakefield s 46 Legacy

47 So who can you trust? 47 Centers for Disease Control College of Physicians Immunization Action Coalition Vaccine Education Center

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51 Mar 95: measles -UC patent Timeline Jun 97: monovalen t measles vax patent Feb 98: Lancet article Feb 96: legal retainer Jul 96: 1 st child enrolle d Dec 99: study replicatio n ordered 51

52 Oct 01: fired Jan 03: 79% MMR coverage in UK Mar 04: 10 coauthors drop Feb 04: research funding revealed Nov 04: vax patent revealed 52

53 Apr 06: 1st measles death May 2010: Wakefield is erased from UK medical register 53 Jul 07: misconduc t inquiry Feb 10: Lancet retraction