Tag: deaths from vaccine-preventable diseases

Why Do We Only Worry About Measles?

Anti-vaccine folks often claim that health officials only worry about measles and measles outbreaks.

They can’t understand why anyone gets concerned by a few measles cases here and there, not understanding that a lot of work goes into containing measles outbreaks and making sure that they don’t grow beyond a few cases.

And health officials don’t just worry about measles. They work to control outbreaks of mumps, pertussis, hepatitis A, and all other diseases too.

Why We Worry About Measles Outbreaks

We do get concerned about measles outbreaks though.

“Whenever measles strikes, it’s more than just an outbreak of a single disease, or an indication that children aren’t receiving their measles shots; it’s also a warning that immunization coverage in general, for all vaccine-preventable diseases, is lower than it should be.

To put it another way: When rates of routine vaccination—children receiving all their shots on schedule, as a preventive measure rather than a reaction to an outbreak—start to fall, the first sign is usually a measles outbreak.”

Seth Berkley on Measles Outbreaks Are a Sign of Bigger Problems

The measles vaccine is among the most effective vaccines we have, so if we are seeing outbreaks, even though measles is very contagious, it means there is a problem.

“A focus on measles surveillance can help detect populations unreached by immunization systems and, by extension, program weaknesses. Measles serves as the ‘canary in the coal mine’ for detecting problems with immunization programs, a characteristic whose importance has recently been highlighted in the context of global health security.”

Orenstein et al on Measles and Rubella Global Strategic Plan 2012–2020 midterm review

In the late 1980s, when we had large outbreaks between 1989 to 1991, with 55,622 cases and 123 deaths, it meant that we weren’t vaccinating enough kids because Federal support for vaccine programs had dropped.

As much as anti-vaccine folks like to try and minimize how serious measles can be, it is easy to see that measles is indeed a serious, life-threatening disease. We had good nutrition, proper sanitation, and modern health care in 1990, and still, a lot of people died with measles. Rates of subacute sclerosing panencephalitis (SSPE), a late complication of measles, went up too, in the years after these outbreaks.

“Measles is a wholly preventable disease, and it was almost eradicated from the country in 1983, when only 1,497 cases were reported. But by 1990, after Federal budget cuts and the end of the Government’s monitoring of immunization programs, more than 30,000 cases of measles and more than 60 deaths were reported.”

Panel Ties Measles Epidemic to Breakdown in Health System

Those outbreaks were fixed, as we improved access to help kids get vaccinated and protected. Unfortunately, the issue with outbreaks today isn’t about access to vaccines, at least not in the developed world. It is about parents intentionally skipping or delaying vaccines.

How do you fix that?

Hopefully with education.

Why You Should Worry About Measles Outbreaks

Did you know that after the measles outbreaks of 1989, we also saw outbreaks of rubella and congenital rubella syndrome?

  • 396 cases of rubella, 4 deaths, and 2 cases of congenital rubella syndrome in 1989
  • 1,125 cases of rubella, 8 deaths, and 32 cases of congenital rubella syndrome in 1990
  • 1,401 cases of rubella, 1 death, and 34 cases of congenital rubella syndrome in 1991

Did you know that because they have overall lower vaccination rates, measles outbreaks in Europe grow far larger, into the tens of thousands of cases, with dozens of deaths?

“We must not tolerate a world in which a child dies from a disease that can be easily prevented with a low-cost vaccine.”

Dr Tedros, WHO Director-General on World Immunization Week 2018

We worry about measles outbreaks, because we don’t want to go back to anti-vaccine folks push us back to pre-vaccine era levels of disease and deaths.

We know what happens when vaccine levels drop too low.

A measles epidemic hit New York City in 1951, as this front page NYTimes article reports.
A measles epidemic hit New York City in 1951, as this NY Times article reports.

We know that vaccines are safe and necessary.

You should know that anti-vaccine propaganda that scares parents away from vaccinating and protecting their kids is rooted in myths and misinformation. They often get away with it because most parents today ahve never seen how devastating measles and other diseases can really be, so they believe stories about the Brady Bunch, instead of the advice of real experts.

You hopefully understand that’s a mistake.

More on Worrying About Measles Outbreaks

Learn the Risks of Following Bad Advice

Who do you turn to for health advice?

Even if it’s your pediatrician, with the rise of holistic pediatricians, that doesn’t mean that you are getting good advice.

In general, if the advice you are getting lacks evidence that it is safe and effective, relies on anecdotes and testimonials, and is labeled as ‘alternative,’ then it is a safe bet that it is bad advice.

Learn the Risks of Following Bad Advice

Some folks seem to be drawn to this type of advice though.

Kat Von D has decided that she will be raising a vegan child, without vaccinations.
Kat Von D has decided that she will be raising a vegan child, without vaccinations.

As long as they think it is natural, holistic, and is the opposite of what mainstream health experts say to do, some parents will jump at the chance of trying the latest fad, even if it has no benefits and lots of extra risks.

Take giving your kids raw milk for example. Health experts have been warning about the dangers of drinking raw milk for years and even work to keep selling it outlawed in most communities, but some parents still give it to their young children. This is despite the fact that it has no health benefits and isn’t even fortified with vitamin D!

Would you give your kids raw milk if you knew it could make them critically ill?
Would you give your kids raw milk if you knew it could make them critically ill?

What’s worse than giving your kids raw milk? How about skipping your baby’s vitamin K shot? Although it has no major risks, parents of many anti-vaccine and holistic type Facebook groups on the internet are often encouraged to skip this shot.

The article, translated from Polish, describes anti-vaccine parents and their baby (Maluszek), who died of vitamin K deficiency bleeding.
The article, translated from Polish, describes anti-vaccine parents and their baby (Maluszek), who died of vitamin K deficiency bleeding because they skipped his vitamin K shot.

How come they never warn folks that their baby might die in agony if they skip the shot? After all, there is a very good reason that we started to give all babies vitamin K shots – to stop vitamin K deficiency bleeding.

Just like there is a reason that we started to pasteurize milk – to keep us all from getting critically ill from contaminated milk.

And why we take antibiotics for severe infections, and not essential oils.

“If one gets a cancer diagnosis, they need to detox the toxins that have accumulated in the body, minimize further exposure and boost the immune system to fight the cancer. This is done NATURALLY. Traditional medical approaches (drugs, chemo, radiation) only FURTHER damage the body and immune system.”

Brandy Vaughan for Learn the Risk

And why we take chemotherapy for cancer, and not coffee enemas.

Mud wraps don't cure liver cancer.
Mud wraps don’t cure liver cancer.

And why most of us don’t think to try chiropractic, acupuncture, Ayurveda, homeopathy, Reiki, reflexology, or other non-evidenced based therapies when our kids are sick.

Could someone search for advice on Google on treating a bite from a rabid animal and come away thinking their child doesn't need rabies shots from an anti-vaccine website?
Could someone search for advice on Google on treating a bite from a rabid animal and come away thinking their child doesn’t need rabies shots from an anti-vaccine website?
Can an unvaccinated child really get tetanus after a toe nail injury?
Can an unvaccinated child really get tetanus after a toe nail injury? Photo by Petrus Rudolf de Jong (CC BY 3.0)

Why don’t people get rabies very often any more? It’s not because folks are no longer at risk, although the risk is less because dogs and cats are now vaccinated. It is because the vast majority of people get treated if they are exposed to an animal that might have rabies.

Remember when the six-year-old boy in Florida didn’t after touching a rabid bat? He died.

It’s just like the reason kids don’t get stuck by lightning very often. It’s not because lightning doesn’t happen anymore. It’s because we get a lot of warnings about thunderstorms and we know to go inside at the first sign of lightning in the area. Lightning strikes are rare because we take steps to reduce our risk of getting hit.

Why don’t folks get tetanus that much anymore? Again, most people are vaccinated, and they get boosters if they have wounds that puts them at extra risk. While we know what happens when unvaccinated kids are exposed to tetanus and don’t get treated, that isn’t a risk that you will read about on anti-vaccine websites or Facebook groups.

They also don’t tell you that kids in the US still die of diseases like Hib and rotavirus. And there are still measles deaths in the US.

That’s why the great majority of us get vaccinated, because we understand that vaccines are safe and necessary, and that skipping or delaying any vaccines simply puts our kids at risk to catch one of the diseases the vaccines are designed to prevent.

What to Know About the Risks of Following Bad Advice

You might get lucky and have a good outcome when you follow bad advice, but you should at least understand the risks of what might go wrong if you truly think you are making an informed decision.

More on the Risks of Following Bad Advice

How Many People Die from Vaccine Preventable Diseases These Days?

People don’t often die from vaccine-preventable diseases these days.

At least not in industrial countries.

Deaths from Vaccine-Preventable Diseases Today

Well, they aren’t supposed to.

Dr. Bob Sears actually reassured parents that measles wasn't deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe - another well-nourished population with lower vaccination rates than the U.S.
Dr. Bob Sears actually reassured parents that measles wasn’t deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe – another well-nourished population with lower vaccination rates than the U.S.

Tragically, we are seeing more and more deaths from vaccine-preventable diseases every day in countries that once had these diseases under good control:

  • over 100 measles deaths across Europe and a measles death in the United States a few years ago
  • diphtheria deaths in Australia, Belgium, South Africa, and Venezuela
  • life-threatening tetanus cases in Australia, Canada, New Zealand, and Ukraine
  • a rabies death in the United States in a child who’s parents skipped the post-exposure rabies vaccine
  • pertussis deaths in the United States
  • influenza – a record number of deaths in the United States, with most kids unvaccinated
  • rotavirus – yes, unvaccinated kids still die of rotavirus in the United States in the 21st Century! In a recent outbreak in California, in which a child died, almost all of the kids were unvaccinated.

And not surprisingly, these deaths are almost always in unvaccinated children.

Deaths from Vaccine-Preventable Diseases in the Pre-Vaccine Era

While tragic, we are still fortunate that these deaths are no where close to the levels we once saw before we had vaccines to protect our kids.

In the pre-vaccine era, we used to see:

  • up to 15,000 deaths and 200,000 diphtheria cases each year until the 1940s
  • an average of 175,000 cases of pertussis each year in the early 1940s, with about 1,118 deaths from pertussis in 1950 and 467 deaths from pertussis in 1955
  • up to 20,000 cases of paralytic polio each year until the early 1950s
  • an average of about 186,000 cases of mumps each year before 1967, with an average of 40 deaths a year
  • up to 500 deaths and 500,000 measles cases each year until the early 1960s
  • a rubella epidemic in 1964-65 that caused 12.5 million rubella virus infections and “resulted in 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 infants born with congenital rubella syndrome”
  • up to 20,000 cases of invasive H. influenzae (Hib) disease each year, with more than half of them having meningitis, and about 300 to 600 deaths, mostly children under age 2 years. In 1980, 45 children died with epiglottitis and there were an additional 222 deaths from Hib meningitis.
  • up to 11,000 hospitalizations and 100 chicken pox deaths each year until 1995
  • up to 17,000 cases of invasive pneumococcal disease in children younger than 5 years each year (before 2000), including 13,000 cases of bacteremia (blood infection) and 700 cases of pneumococcal meningitis, with 200 deaths.
  • just over 400,000 visits to the doctor and up to 272,000 visits to the emergency room, 70,000 hospitalizations and 20 to 60 deaths each year in children under age 5 years because of rotavirus infections until 2006

But that deaths from vaccine-preventable diseases aren’t common is hardly a reason to skip or delay your child’s vaccines, as some might suggest. It is just testament to the fact that vaccines work.

That these deaths from vaccine-preventable diseases quickly rise as rates of vaccinations drop is a tragic reminder that vaccines are necessary.

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

And what makes it even more tragic is that this was all predicted and could have been prevented if folks didn’t listen to anti-vaccine propaganda that scares them away from vaccinating and protecting their kids.

Worldwide Deaths from Vaccine-Preventable Diseases

Of course, talk of deaths from vaccine-preventable diseases shouldn’t stop with the developed or industrial world.

Even as a lot of progress is being made, as more and more people get vaccinated, worldwide, there were:

  • about 89,780 measles deaths, mostly young children
  • about 215,000 deaths from rotavirus infections
  • at least 1 million deaths from hepatitis B
  • almost 200,000 deaths from Hib
  • over 4,200 deaths from chicken pox
  • about 50,000 deaths from meningococcal infections
  • about 160,000 deaths from pertussis
  • about 826,000 deaths from pneumococcal infections
  • almost 60,000 deaths from rabies
  • just over 70,000 deaths from tetanus
  • about 222,000 deaths from typhoid
  • between 30,000 to 60,000 deaths from yellow fever

As you can see, most of these diseases are still big killers around the world.

“You hear about people who don’t like to vaccinate their kids in the Western world, which I suppose is a personal choice, but when you’re out there, the result of your children not being vaccinated is that they’ll likely die, or be horribly maimed. So yes, I saw a real desire to have their children protected, and also a real understanding of it – I didn’t seem to come across anybody who went ‘What is it?’ Or ‘What does it do?’ They all seemed to know about it.”

Ewan McGregor on Cold Chain Mission

In most of these countries, the problem is access to vaccines though, not parents refusing to get their kids vaccinated.

What to Know About Deaths from Vaccine Preventable Diseases

Unvaccinated kids are still dying from vaccine-preventable diseases.

More on Deaths from Vaccine Preventable Diseases

Has the United States’ Infant Mortality Rate Ranking Been Dropping as We Vaccinate More Kids?

Of all of the myths about vaccines that confuse and scare some parents, those about infant mortality rates can be especially hard to easily put aside.

After all, why doesn’t the United States rank better for infant mortality rates since most parents do vaccinate and protect their kids?

Vaccines and Infant Mortality Rates

That’s actually fairly easy to answer.

“Globally, the infant mortality rate has decreased from an estimated rate of 64.8 deaths per 1000 live births in 1990 to 30.5 deaths per 1000 live births in 2016.”

WHO on Infant Mortality Situation and Trends

Vaccine-preventable diseases don’t have much effect on infant mortality rates in the United States these days.

What does?

  • birth defects
  • premature births
  • SIDS
  • maternal complications of pregnancy
  • injuries

Think about it… If vaccines did increase infant mortality rates, then why would infant mortality rates be dropping as we vaccinate more kids?

Has the United States’ Infant Mortality Rate Ranking Been Dropping as We Vaccinate More Kids?

The Wisconsin Coalition for Informed Vaccination is pushing myths about SIDS and vaccines.
The Wisconsin Coalition for Informed Vaccination is pushing myths about infant mortality rates and vaccines.

Do you know what has been dropping?

The infant mortality rate.

In fact, infant mortality rates continue to drop and are now at their lowest levels ever.

While it is good news that the rate is dropping, most folks think they can be better.

For one thing, some states, like Mississippi, Louisiana, Alabama, Arkansas, and West Virginia, etc., have much higher infant mortality rates than others. Why? Much of those differences, can be explained by socio-economic factors. That’s also though to explain much of the differences in infant mortality rates between the U.S. and other developed countries, most of which have universal health care.

New Jersey, although they have ranked high for autism rates, has lower than average rates of infant mortality.
New Jersey, although they have ranked high for autism rates, has lower than average rates of infant mortality.

Another big difference is that many countries count infant mortality rates using different criteria than the United States.

For example, it is estimated that at least 40% of the differences between infant mortality rates in the United States and other countries is due to those countries not counting extremely preterm births among their statistics.

But why has the United States’ infant mortality ranking fallen relative to other developed nations?

Most European Countries had much higher infant mortality rates than the US in the 1960s and 70s, which affected relative rankings, even as all countries saw infant mortality rates fall.
OECD data shows that most European Countries have historically had much higher infant mortality rates than the US, which have affected relative rankings, even as all countries have seen infant mortality rates fall.

Although anti-vaccine groups try to tie this to ‘routine vaccination,’ it is easy to see that other countries have historically had much higher infant mortality rates than the United States. As they have caught up, the United States’ ranking has dropped relative to theirs, even though all have seen infant mortality rates drop.

Infant Mortality Rates in the Pre-Vaccine Era

But if you really want to understand the relationship of vaccines to infant mortality rates, you just have to look back to the pre-vaccine era. Back then, now vaccine-preventable diseases did have a big effect on infant mortality rates in the United States and elsewhere.

In 1910, for example, the most common causes of death for infants under 1 year were:

  1. diarrhea and enteritis
  2. premature birth
  3. congenital debility
  4. bronchopneumonia
  5. pneumonia
  6. malformations
  7. bronchitis
  8. convulsions
  9. injuries at birth
  10. whooping cough
  11. tuberculosis
  12. meningitis
  13. measles
  14. accident
  15. diphtheria

Although advances in modern medicine would help decrease the mortality from many of those diseases, it was vaccines that truly worked to make sure they were no longer a big part of our infant mortality statistics.

How will we continue to decrease our infant mortality rates?

Most experts think that it will require better access to health care for all members of society.

What to Know About Infant Mortality Rate Rankings

Infant mortality rates are not linked to vaccines.

More Infant Mortality Rate Rankings

Dear Anti-Vaxxers,

As someone who has always understood that vaccines are safe and necessary, who vaccinates his children, I’m asking you to hear me out.

Dear anti-vaxxers. Vaccinate your kids.

I don’t think that you are either stupid, uneducated, crazy, or that questioning vaccine safety is always associated with  believing in conspiracy theories.

I understand and appreciate that you do care about your children, that you care about their health, and that you want what’s best for your family.

I actually do get that. I really do.

But I know that while you believe that you have done years of research and investigation to help you decide that the potential benefits of vaccines don’t outweigh their risks, going out of your way to find information to support your decision and ignoring all of the rest that says you are wrong, isn’t really doing research.

Whether you have never set foot on a college campus, you have a PhD in immunology, or you are a toxicologist, I know that you are still vulnerable to the same cognitive biases, heuristics, and logical fallacies as everyone else, and those can keep you from coming to a truly informed decision.

And I know that you are mostly motivated by fear, anger, and mistaken ideas of vaccine injury, vaccine induced disease, and unexplained illness and sudden deaths.

We all care about our children and families. The difference between us is that you still believe that there are two sides to the vaccination debate.

There isn’t.

Vaccines are safe, necessary, and they work well to protect our kids from life-threatening vaccine-preventable diseases.

No, vaccines are not 100% safe and they don’t work 100% of the time, but neither are they responsible for all of the things you see in vaccine scare stories or all of the so-called vaccine induced diseases we hear about.

“What if doctors never actually learn about vaccines, their ingredients, or adverse events, in medical school? What if the medical textbooks are written with an enormous amount of funding from the pharmaceutical industry? What if the CDC owns patents on vaccines? What if the pharmaceutical industry is corrupt and funds studies which conveniently stop monitoring test subjects before adverse effects begin to manifest? What if vaccines contain toxic substances at levels which can cause chronic illness when children are repeatedly injected with them? What if we are trading temporary illness for the development of autoimmune and neurological disease later in life? What if the threat and danger of these “preventable” diseases has been inflated to push more vaccines? What if these vaccines are not even truly effective as we have been led to believe and we will always need more booster shots to try to make up for that fact? What if there is evidence for all of the above, you just haven’t seen it yet?”

Ashley Everly Cates

Listen.

If you don’t want to vaccinate your kids, then don’t.

But don’t be influenced by folks who say they have done their research and don’t believe in conspiracy theories, but use a book by Neil Z Miller as a reference and push every major anti-vaccine conspiracy theory.

And don’t expect that your vaccine choice will be consequence free, including that your child will be at increased risk to get a vaccine-preventable disease, you will be putting others at risk to get a vaccine-preventable disease if your intentionally unvaccinated child gets sick, and you may be kept out of daycare or school if you live in a state that doesn’t allow non-medical exemptions.

I hope that you will keep an open mind and genuinely take time to look into this for yourself, beyond the myths and claims of anti-vaccine heroes who ignore or are unaware of the massive amount of evidence that contradict their claims.

Please take caution and know that I don’t do this to be popular. I don’t do this to make friends, get likes on my Facebook page, or sell vitamins and supplements in an online store.

Truly. The only reason I speak out is to protect my children and your children from unnecessary harm.

After all, is it really so hard to believe that the great majority of pediatricians, infectious disease specialists, immunologists, toxicologists, and public health experts in the world and throughout history are right about vaccines?

More for Anti-Vaxxers

Did Sweden Ban Mandatory Vaccination?

Have you heard the “news” that Sweden banned mandatory vaccination in their country?

Is that true?

Did Sweden Ban Mandatory Vaccination?

Like most other anti-vaccine myths, this one isn’t true.

Sweden did not ban mandatory vaccination.

“…vaccination coverage is still high and stable, that the diseases covered by the programs are under control…”

Riksdag Social Committee report 2016/17: SoU7

In March 2017, the Riksdag, or Swedish parliament, did vote against a proposal that called for mandatory vaccination. This came as other countries in Europe are seeing lower rates of immunization, rising rates of vaccine-preventable disease, and calls for vaccine mandates. In fact, France and Italy recently implemented vaccine mandates.

“The general vaccination program has a good coverage, and most children are protected against measles and polio, for example. There are, however, skepticism about vaccinations, both the vaccinations included in the basic program and others. In our view, however, it is of societal interest that the vaccination program is implemented in its entirety, and many of the myths and incorrect data circulating about the vaccination program need to be treated and pinned. We therefore consider that the government should provide the appropriate authority with the task of designing an information campaign on the benefits and necessity of the childhood vaccination program.”

Riksdag Social Committee report 2016/17: SoU7

Although the Swedish parliament voted against a motion that would have started a mandatory vaccination plan, there was nothing to ban. Sweden has never had a mandatory vaccination.

The Riksdag passed a motion to add the rotavirus vaccine to the immunization schedule in Sweden.
The Riksdag did pass a motion to add the rotavirus vaccine to the immunization schedule in Sweden.

It is also clear that they see the problem that anti-vax groups are causing in their country and are working to combat them.

That will hopefully keep them from needing a mandatory vaccination program.

What to Know About the Myth of Sweden Banning Mandatory Vaccination

Sweden, with good immunization levels and low rates of vaccine-preventable disease, did not ban mandatory vaccination.

More on the Myth of Sweden Banning Mandatory Vaccination

Are More People Dying of Viral Hepatitis?

We have two vaccines to protect folks against viral hepatitis.

The first, against hepatitis B, was developed in 1981, but was replaced by an improved vaccine in 1989. It wasn’t added to the immunization schedule until 1991 though. Next came the hepatitis A vaccine in 1996.

Are More People Dying of Viral Hepatitis?

Although we don’t often think of them that way, these types of hepatitis can cause life threatening infections. Hepatitis B can even cause cancer!

Are deaths from hepatitis really skyrocketing?
Are deaths from hepatitis really skyrocketing?

So why would more people be dying of hepatitis A and B after we developed vaccines to help prevent them, a new idea being pushed by anti-vaccine folks?

They aren’t.

For example, there were 31,582 cases of hepatitis A and 142 deaths in 1995, just before the vaccine was approved. In 2016, there were just over 2,000 cases and 70 deaths.

What about hepatitis B?

The record high for yearly new cases was in 1985. In 2016, we are near record lows, with 3,218 new cases and 1,698 deaths.

Why are people still dying of hepatitis B?

Because even though far fewer people are getting new infections, there are still an estimated 850,000 to 2.2 million adults in the United States who already have chronic hepatitis B infections.

“…rates of acute Hepatitis B in the United States have declined by approximately 82% since 1991.”

Hepatitis B FAQs for the Public

So how can they say that hepatitis deaths are skyrocketing?

It’s easy. It is classic anti-vaccine propaganda. To fool folks, they talk about “all strains” of hepatitis and not just vaccine-preventable types.

Remember, there are multiple types of hepatitis, including A, B, C, D, and E. These are all caused by different viruses, even though they all cause hepatitis.

And since 2006, the incidence of hepatitis C has been climbing sharply. Tragically, so have the number of deaths. In 2016, there were 18,153 deaths from hepatitis C, which is not yet vaccine-preventable.

Hepatitis deaths are increasing.

All strains? Nope. Just the non-vaccine preventable strains. Deaths from hepatitis A and hepatitis B have greatly decreased since the pre-vaccine era.

All ages? Nope. Children have been protected from rising hepatitis deaths, as they are not typically at high risk for hepatitis C, which is causing the surge in deaths, and they should be vaccinated and protected against hepatitis A and hepatitis B.

What to Know About Viral Hepatitis Deaths

Viral hepatitis deaths are increasing, but only for non-vaccine preventable strains.

More on Viral Hepatitis Deaths