January 18 – This Day in Vaccine History

Would folks be more likely to get vaccinated and protected if they remembered what it was like in the pre-vaccine era?

Since anti-vaccine folks like to make it sound like cancer, heart disease, kidney disease, and everything else are caused by vaccines, will they be surprised to know that in addition to now vaccine-preventable diseases, they were big killers in the pre-vaccine era?
Since anti-vaccine folks like to make it sound like cancer, heart disease, kidney disease, and everything else are caused by vaccines, will they be surprised to know that in addition to now vaccine-preventable diseases, they were big killers in the pre-vaccine era?

A lot of people died of diseases that are now vaccine-preventable, and no, you can’t simply thank better hygiene and nutrition instead of vaccines for saving all of those lives.

A lot of people were still getting smallpox in 1920.
A lot of people were still getting smallpox in 1920.

Since the smallpox vaccine has been around for hundreds of years, can you believe that people were still getting and dying of smallpox 100 years ago?

How about 50 years ago?

January 18, 1970 - everyone was excited about all of the progress that was being made in getting smallpox under control.
January 18, 1970 – everyone was excited about all of the progress that was being made in getting smallpox under control.

That’s hard to imagine, isn’t it, as it was long known how to control smallpox with quarantines and vaccination.

On January 18, 1870, the Chicago Tribune described how Chicago was getting smallpox under control - by getting folks vaccinated.
On January 18, 1870, the Chicago Tribune described how Chicago was getting smallpox under control – by getting folks vaccinated.

Still, it took a long time before smallpox was finally declared eradicated.

And with smallpox under control, fifty years ago, many communities were eager to get kids vaccinated and protected to stop measles.

This paper in Nebraska announced "Stop Measles Day" on January 18, 1970.
This paper in Nebraska announced “Stop Measles Day” on this day in vaccine history – January 18, 1970.

Something changed once we got these diseases under control though.

Can you guess what it was?

Todd Wiley was convicted of manslaughter for shaking his child, but his “DPT defense” made the papers for months, including this article on January 18, 1995.

There were more and more vaccine scare stories in the media. Initially they were about the DPT vaccine and they then moved on to MMR once Andrew Wakefield hit the scene.

The Disneyland measles outbreak was well underway on January 18, 2015.

And even though none of the stories were true, that didn’t stop them from influencing people.

Have we learned our lesson?

Do we need to repeat history?

Vaccines are safe, with few risks, and are obviously necessary.

Anti-vax groups are raising money in Maine and elsewhere to influence parents and politicians and new vaccine laws.
Anti-vax groups are raising money in Maine and elsewhere to influence parents and politicians and new vaccine laws.

Vaccinate and protect your kids. Don’t bring back these deadly diseases.

More on History of Vaccines

When Was the Last Case of Rubella in the United States?

While we rarely hear about rubella anymore, like most other vaccine-preventable diseases, the last case of rubella in the United States was a lot more recent than you probably imagine.

Austin recently had its first case of rubella in twenty years.

Although endemic rubella and congenital rubella syndrome were declared eliminated in 2004, like measles, we still have cases each year.

When Was the Last Case of Rubella in the United States?

To be sure, rubella is far less common that it used to be.

Remember the rubella epidemics of the 1960s, when rubella caused 2,100 neonatal deaths and 20,000 infants to be born with congenital rubella syndrome?

If natural herd immunity really works, how do you explain congenital rubella syndrome in the pre-vaccine era and in countries that don't use the rubella vaccine?
If natural herd immunity really works, how do you explain congenital rubella syndrome in the pre-vaccine era and in countries that don’t use the rubella vaccine? Why doesn’t everyone get natural immunity when they are younger and rubella is milder, avoiding the chance of getting sick when they are pregnant?

How about the rubella outbreaks in the early 1990s, when rubella caused 13 deaths and 77 cases of congenital rubella syndrome?

“Rubella is a leading cause of vaccine-preventable birth defects. Although rubella virus infection usually causes a mild febrile rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS).”

Grant et al on Progress Toward Rubella and Congenital Rubella Syndrome Control and Elimination — Worldwide, 2000–2018

One of our problems today is that most people don’t remember these epidemics and outbreaks, so they don’t understand how important it is for everyone to be vaccinated and protected.

They have no idea how fortunate they are that these diseases no longer make routine headlines.

But what happens if too many people skip or delay their vaccines?

Japan is still dealing with a large outbreak of rubella, with resulting cases of congenital rubella syndrome.

We will see more rubella and congenital rubella syndrome.

There were five cases of congenital rubella syndrome in the United States in 2017, all import related.
All five cases of congenital rubella syndrome in the United States in 2017 were import related.

While we do see some congenital rubella cases now, they are all women who were exposed to rubella outside the United States when they were pregnant.

“During 2001–2004, four CRS cases were reported to CDC; the mothers of three of the children were born outside the United States.”

Achievements in Public Health: Elimination of Rubella and Congenital Rubella Syndrome — United States, 1969–2004

Again, since the endemic spread of rubella was declared eliminated in 2004, cases since then are import related. People who aren’t immune get exposed to rubella when they are traveling to areas of the world where rubella is more common and return. Fortunately, since rubella isn’t as contagious as measles, these cases don’t usually cause big outbreaks.

So when was the last case of rubella and congenital rubella syndrome in the United States that wasn’t imported from outside the United States?

It was just before 2004.

Let’s get everyone vaccinated and protected before we see the next case.

More on Rubella and Congenital Rubella Syndrome

Is the Flu Deadlier This Year?

Why do people seem to think that the flu is deadlier this year?

Everyone has a prediction about flu season, but it is still too early to tell if this year will be deadlier than others.
Everyone has a prediction about flu season, but it is still too early to tell if this year will be deadlier than others.

It seems like we get these kinds of warnings and predictions every year.

Is the Flu Deadlier This Year?

Is it true this year?

“Levels of outpatient ILI remain elevated; however hospitalization rates and percent of deaths due to pneumonia and influenza remain low. This is likely due to the predominance of influenza B/Victoria and influenza A(H1N1)pdm09 viruses which are more likely to affect children and younger adults than the elderly. Because the majority of hospitalizations and deaths occur among people age 65 and older, with fewer illnesses among that group, we expect, on a population level, to see less impact in flu-related hospitalizations and deaths.”

Weekly U.S. Influenza Surveillance Report, Key Updates for Week 1, ending January 4, 2020

It is certainly true that we are seeing more pediatric flu deaths at this time of year than usual, but we don’t usually have such an early start to the flu season!

“This season so far has been particularly deadly for children, with 27 deaths reported through December 28. That’s the highest number of deaths at this point in the season since the CDC started keeping track 17 years ago.”

Elizabeth Cohen on US on track for one of the worst flu seasons in decades

If flu season also peaks and ends earlier than usual, than it might not end up being an overly severe flu season.

Will it be a deadly flu season?

Of course.

It’s flu season!

“The overall cumulative hospitalization rate was 14.6 per 100,000 population which is similar to what has been seen during recent previous influenza seasons at this time of year.”

Weekly U.S. Influenza Surveillance Report, Key Updates for Week 1, ending January 4, 2020

But there is not yet good evidence that this season is or will be much worse or deadly than others.

Influenza-like Illness numbers don't say anything about the severity of flu illness.
Influenza-like Illness numbers don’t say anything about the severity of flu illness.

Or that this year’s flu vaccine won’t be effective. We won’t get a report on the effectiveness of this year’s flu vaccine until next month.

“Although the V1A.1 and V1A.3 subclades are genetically distinct, sera from previous studies conducted among humans vaccinated with a V1A.1 virus cross-reacted well with B/Victoria viruses with a three amino acid deletion, such as the V1A.3 viruses. These findings suggest that vaccination with the current season’s vaccine might offer protection against circulating B/Victoria viruses.”

Early Season Pediatric Influenza B/Victoria Virus Infections Associated with a Recently Emerged Virus Subclade — Louisiana, 2019

And while we already know that this year’s flu vaccine isn’t a perfect match, it should offer protection.

Flu mortality surveillance data is still below epidemic threshold, although it is unlikely to stay there much longer.
Flu mortality surveillance data is still below epidemic threshold, although it is unlikely to stay there much longer.

Unfortunately, early flu seasons don’t always peak and end early. And they are sometimes among the worst, like the 2012-13 flu season. But that was an H3N2 season, which often are worse than others.

This year we are in new territory, having an early season that has been dominated by a flu strain B. Since it is not something we have seen before (at least not since the since the 1992–93 season), you can expect the unexpected, just like you should always do when it comes to the flu.

And know that there is really only one prediction that will end up holding true, that a yearly flu vaccine is the best way to protect your family from the flu.

More on Flu Deaths

Why Do We Combine Vaccines?

Do you know why they combine multiple vaccines into a single shot?

Have you ever wondered why we combine vaccines? It's not a conspiracy...
It’s not a conspiracy…

Not surprisingly, your answer likely says a lot about what you think about vaccines…

Why Do We Combine Vaccines?

Combination vaccines aren’t new.

The DPT vaccine was one of the first vaccines to be combined and that was way back in 1948. Before that, protection against diphtheria, tetanus, and pertussis came from three separate injections.

Want your child to get single antigen vaccines instead of a combo because you think they are getting too much in a combination vaccine? Keep in mind that the original DTP vaccine contained 3,002 antigens in each dose. And now, they get about 650 antigens from all of the vaccines they get during their whole childhood!

Which combination vaccine came next?

No, it wasn’t MMR.

How many antigens did kids get with this old schedule?

When the first polio vaccines came out, kids got three separate vaccines against the three strains of polio. They were later combined into the single polio vaccines.

And to reduce the number of injections even further, from 1959 to 1968, Quadrigen, a DTP/Polio combination was available!

And then came the MMR combination vaccine in 1971, combining protection against measles, mumps, and rubella into one shot.

Are you starting to see why we combine vaccines?

It helps reduce the number of injections that a child receives at one visit.

It has nothing to do with trying to hide any proof of a vaccine injury, after all, most parents still get their kids the same vaccines, whether or not they are combined.

Is it to save money?

In general, combination vaccines are about the same price as individual vaccines. Some are a little more and some are a little less.

It is typically easier to order, store, and administer a combination vaccine than each of the individual vaccines separately though, which can save moey. Using combination vaccines may also help to reduce errors.

Still, combining vaccines has never been about anything more than reducing the number of shots that kids have to get to be protected.

“So, at a doctor’s visit, your child may only get two or three shots to protect him from five diseases, instead of five individual shots. Fewer shots may mean less pain for your child and less stress for you.”

CDC on Combination Vaccines

Combination vaccines allow kids today to get 10 vaccines to protect them against 14 vaccine preventable diseases, but as few as 23 individual shots by age five years.

“Combination vaccines were associated with improved completion and compliance and should be encouraged among children who are undervaccinated or who received single-antigen vaccines only.”

Kurosky et al on Effect of combination vaccines on completion and compliance of childhood vaccinations in the United States

And it helps to keep vaccination rates up!

More on Combination Vaccines