IMMUNIZATIONS: WHAT S

Transcription

1 IMMUNIZATIONS: WHAT S TRUE AND WHAT S NOT LORAINE STERN, MD CSUN March 9, 2010

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3 Who decides what a child needs? Each year, top disease experts and doctors who care for children work together to decide what to recommend that will best protect U.S. children from diseases. The schedule is evaluated each year based on the most recent scientific data available. The schedule is approved by the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians.

4 How is the timing determined? First, it is scheduled for the age when the body s immune system will work the best. Second, it is balanced with the need to provide protection to infants and children at the earliest possible age.

5 Should any children not receive vaccines? Children with certain health problems may not be able to get some vaccines or may need to get them later. Since each child is different, your child s doctor will know what is best for your child.

6 Common Concerns Information and misinformation

7 MMR and Autism The claim The measles virus enters the body from the vaccine, causes inflammation in the bowel and brain, and leads to autism.

8 MMR and Autism The history Dr Andrew Wakefield published a paper in The Lancet in 1998 with this theory. Since then, other scientists cannot replicate his findings and 10 of his co-authors retracted their support for the study. Twenty other studies have found no association between MMR vaccine and autism. Many people in England decided not to vaccinate with MMR. A measles outbreak ensued, and autism rates did not decline.

9 MMR and Autism MMR vaccine is given at months of age, which is also when symptoms of autism are usually first noticed. Recent measles outbreaks in the United States have affected dozens of children, including some who were too young or too sick to be immunized. The outbreak was started by an unvaccinated child. Sometimes measles vaccine can cause a fever or rash, but never autism.

10 Thimerosal and Autism The claim The mercury in thimerosal causes heavy metal buildup in the body which cannot be excreted, affecting brain function and causing autism.

11 Other Ingredients The claim Vaccines need to be greener. The history Since thimerosal and MMR seem not to be the cause of autism, celebrity theories have shifted to 2 new arguments. First, vaccines should be greener. Second, that vaccines overwhelm the immune system.

12 Other Ingredients The amount of each additive used in vaccines is very small. In fact, we are exposed to much higher levels of these chemicals in our everyday lives. In vaccines, these ingredients are used to make the vaccine safer and more effective. Each vaccine is tested many times to make sure it is safe and works. Taking ingredients out might affect the ability of the vaccine to protect a child.

13 Overwhelming the Immune The claim System Giving a baby too many vaccines at once overwhelms her immune system. The history This is the second theory that celebrities have touted, since others have been proved incorrect.

14 Overwhelming the Immune System Infants and children are exposed to many germs every day just by playing, eating, and breathing. Their immune systems fight those germs, also called antigens, to keep the body healthy. The amount of antigens that children fight every day (2,000-6,000) is much more than the antigens in any combination of vaccines on the current schedule (150 for the whole schedule). So children s immune systems are not overwhelmed by vaccines.

15 Overwhelming the Immune System The vaccine schedule is not one size fits all. The schedule is considered the ideal for a healthy child, but there may be exceptions if a child has certain illnesses. Spreading out the shots leaves your child unprotected for longer. There is no scientific information that delaying shots is safer. Your pediatrician stays up to date with the current schedule and knows your child best.

16 How do I know vaccines are safe? The US has some of the strictest safety testing requirements in the world. Vaccines are first tested by the FDA, which has to show they will work well in children. The CDC and AAP then review the data again before making a recommendation for or against the vaccine. Manufacturing plants must be licensed and are regularly inspected.

17 How do I know vaccines are safe? Vaccines continue to be studied after they are licensed and recommended. The FDA and the CDC created the Vaccine Adverse Event Reporting System (VAERS). All doctors must report serious side effects of vaccines to VAERS so they can be studied. If any problems are found, vaccines are taken off the market. Any new side effects are also communicated to your pediatrician.

18 For More Information AAP CDC National Network for Immunization Information

19 Types of Vaccines Live attenuated vaccines Killed vaccines Toxoids

20 PERTUSSIS (Whooping Cough) cases in US Decreased by 98% Increasing now

21 Diphtheria Top 3 causes of death in children in 1930 s Heart block/chf Now 3 cases/yr Soviet Union 1995, 50,000 cases with 1500 deaths Only preventive approach is immunization

22 Tetanus 30% of cases are fatal 50 cases/yr, mostly unimmunized and/or immunized and not boosted in 10 years Source: American Academy of Pediatrics Source: Maryland Center for Loraine Immunization Stern, MD

23 Polio ,000 paralytic cases cases Change to killed vaccine in early 1960 s because risk from live virus greater than risk from polio Source: US Food and Drug Administration

24 Measles Before 1963, 3-4 million cases, 500 deaths and significant pulmonary and neurologic morbidity Vaccine reduced incidence by 98% U.S. Centers for Disease Control and Prevention

25 Rubella (German Measles) 21,000 neonatal deaths and 20,000 cases of CRS 11,600 deaf, 3,580 blind, 1,800 MR After vaccine, 5-6 cases CRS annually Source: CDC Public Health Image Library

26 Chickenpox parties Risk for invasive Group A strep and staph, Reye s syndrome, aseptic meningitis, encephalitis and congenital varicella Varicella Incidence has declined by about 85% since introduction of vaccine in 1995.

27 HIB Haemophilusinfluenzae type b Most common cause of bacterial meningitis in infants and children under 5 20,000 cases/yr meningitis, with 10% risk deafness, brain damage or death % incidence

28 Pneumococcal vaccine Impressive reduction at first but serotype drift may mean not as effective as HIB Phase 3 trials with 13 serotypes (current vaccine only 7)

29 Rotavirus Almost all children before kindergarten 3 million cases/yr, 70,000 hospitalizations, deaths Still major cause of death in Third World

30 Hep A Dropped more than 75% in states that vaccinate Children as reservoir

31 Meningococcus Crowding (barracks, dorms) and immune deficient outbreaks/yr in US 10% mortality, 11-12% long term sequelae

32 Hep B Body fluids, blood, tatooing, piercing, maternal/fetal transmission 25% of children who develop lifelong hep B have related liver disease as adults - cirrhosis, cancer

33 HPV 9,700 women in the US/yr, 3700 die Most common STD years 50% infected Prevents 70% cancers, 90% genital warts Vaccine for boys?

34 What interferes with effective vaccination levels? Vaccine shortages Distribution and access problems School exemptions Cost to pediatricians Vaccine refusal due too???

35 VACCINE SHORTAGES Production problems - prevnar shortage in 2001, resolved in 2005 W/ vaccine, 15.5/100,000 reduced to 6.5/100,000 Would have been 3.6 but went up to 7.2

36 VACCINE SHORTAGES Production problems - prevnar shortage in 2001 after CDC recommendation, then resolved in 2005 W/ vaccine, 15.5/100,000 reduced to 6.5/100,000 Adult rates also declined although vaccine is only administered to children

37 DISTRIBUTION AND ACCESS US vaccination program saves $10 billion in medical expenses and saves society about $43 billion 40% VFC, 45% private sector, 15% fall through cracks

38 SCHOOL EXEMPTIONS 2006 all states allowed med exemption, 48 religious and 19 personal belief Johns Hopkins and CDC study easier the procedure the more cases of pertussis (90% higher with easiest scenario)

39 COST TO PEDIATRICIANS 1985 $45 for all vaccines 2006 $837 without HPV, $1200 with Insurance and Medicaid reimbursement, especially for new vaccines, is abominable

40 VACCINE REFUSAL MMR and autism 1998 report 12 children with lymphoid hyperplasia in the intestine and 8 with autism Conjectured that MMR cause inflammation that allowed neurotoxin to enter brain

41 MMR and autism HOWEVER: Behavioral symptoms preceded GI sx s Lymphoid hyperplasia is a normal variant in 25% of children A lie can travel around the world while the truth is putting on its pants -- Mark Twain:

42 Studies refuting connection Denmark: 1/2 million children, 82% vaccinated, no difference in autism between imm and non-imm 2001 IOM rejection of causal association but had no effect

43 Thimerosal No evidence that cause any problems at all but eliminated because of parental and public pressure Flu vaccine with trace amounts, parents refuse, rather risk 20,000 deaths/yr from flu

44 Why this loss of confidence? Vaccines are preventive measures, so by their very nature, nothing happens when they are effective Questioning authority - Vietnam war, Watergate Poor media skills of experts Uncritical viewers and thinkers

45 Vaccine Myths Diseases had already begun to disappear before vaccines were introduced, because of better hygiene and sanitation. The majority of people who get a disease have been vaccinated. There are "hot lots" of vaccine that have been associated with more adverse events and deaths than others. Vaccines cause many harmful side effects, illnesses, and even death. Vaccine-preventable diseases have been virtually eliminated from the United States. Giving a child multiple vaccinations for different diseases at the same time increases the risk of harmful side effects and can overload the immune Loraine Stern, system. MD

46 VACCINE TRUTHS Most important public health measure after clean water Fear of vaccines causes public harm Not 100% safe Public has little understanding of the vaccine development process Risk perception is critical

47 VACCINE TRUTHS Parents want what is best for their children Anti vaccine champions are charismatic and convincing Decision not to vaccinate is a decision to accept the risks of the diseases

48 WHAT DETERMINES ACCEPTANCE OF VACCINES Benefit to own child Benefit to society Influence of peer groups Personal experience Perception of risk Perception of disease severity

49 WHAT DETERMINES ACCEPTANCE OF VACCINES? Perception of vaccine dangers Perception of trustworthiness of authority figures, government

50 ROLE OF THE MEDIA If it bleeds, it leads Time and space gives credibility Tobacco researchers vs industry executives Doctors vs mothers who thought vaccines killed their child

51 Bulletin of the Atomic March/ April 2007 Scientists It was widely reported that a band of supposed terrorists arrested in London in 2003 had been producing ricin, a poison none was found but by the time that was cleared up, the press had gone on to other things

52 No one who develops community and national policy would pretend that there are not complications associated with these immunizations or, for that matter, with any medicine. But there is sound science and significant reason for administering our current vaccines and no one can reasonably present to parents that the perceived risks of childhood immunization in any way compares to the horrors of these infections themselves. California Pediatrician, fall 2006