Tag: diphtheria

We Know What Happens If We Stop Vaccinating

It’s no surprise.

If we stop vaccinating, diseases that are now vaccine preventable will come back.

How do we know?

Because it has happened already.

We Know What Happens If We Stop Vaccinating

It has happened a lot, actually.

Remember when Sweden stopped using the DPT vaccine?

Between 1979 and 1996, Sweden suspended vaccination against pertussis because of concerns about the DPT vaccine.

Justus Ström‘s data was wrong…

And what happened?

“In 1979, the Swedish medical society abandoned whole-cell pertussis vaccine and decided to wait for a new, safer, more effective vaccine – a strategy that was soon adopted as national policy. During 1980-83, annual incidence for children aged 0–4 years increased to 3370 per 100000, with rates of serious complications approaching global rates. In subsequent years, Sweden reported more than 10000 cases annually with an incidence exceeding 100 per 100000, comparable to rates reported in some developing countries.”

Ganarosa et al on Impact of anti-vaccine movements on pertussis control: the untold story.

Pertussis came back.

In fact, endemic pertussis came back.

“Our evaluation of pertussis in the unimmunized child population gave an answer to the question of whether pertussis nowadays is a harmless disease which does not demand general vaccination. The present situation regarding pertussis in Sweden and the low efficacy of the antimicrobial treatment indicate an urgent need to prevent the disease by general vaccination as soon as a safe and effective vaccine is available.”

Romanus et al on Pertussis in Sweden after the cessation of general immunization in 1979.

Of course, they already had a safe and effective vaccine at the time. All of the claims against the whole cell pertussis vaccine ended up being untrue.

The same thing happened when Japan stopped using the MMR vaccine.

“Due directly to these gaps in ‘herd’ immunization resulting from politicized transitions in vaccination policy by the government, there were outbreaks of rubella with 17,050 cases reported between the years of 2012 and 2014, and 45 cases of congenital rubella syndrome reported to the National Epidemiological Surveillance of Infectious Diseases from week 1, 2012 to week 40, 2014.”

Yusuke Tanaka on History repeats itself in Japan: Failure to learn from rubella epidemic leads to failure to provide the HPV vaccine

What happened in Ukraine when immunization rates dropped in the 1990s? There were 17,387 cases of diphtheria and 646 deaths from 1992 to 1997. Also high, were cases of measles (over 23,000 cases in 1993) and pertussis (almost 7,000 cases in 1993).

Remember the measles outbreaks that spread across Europe in 2010 to 11, leading to about 30,000 cases of measles each year, and at least 28 deaths?

That should have been enough to warn folks, but it didn’t.

Things are much worse now, with over 120 measles deaths in Europe over the past few years.

More recently, in Venezuela, shortages of most things have led to ongoing epidemics of measles and diphtheria, a “potential for reemergence of poliomyelitis,” and a risk to neighboring countries.

“Officials say the low coverage rate and widespread transmission of the virus is due to many factors, including transport costs for those in rural areas, a high number of people with weakened immune systems, such people living with HIV and tuberculosis – and vaccine refusal.”

Ukraine: Red Cross deployed to help contain largest measles outbreak in Europe in four years

And once again, there are measles outbreaks in Ukraine. This time, they have spread to many other countries, fueling outbreaks in Israel and the United States.

We know what happens if we stop vaccinating. Get vaccinated and stop the outbreaks.

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

More on What Happens If We Stop Vaccinating

When Was the Last Case of Diphtheria?

Believe it or not, measles isn’t the only vaccine-preventable disease that is still around.

While you likely aren’t too surprised about the flu deaths and the cases of meningococcal disease, did you know that kids still get Hib, babies still get hepatitis B, and that there were three cases of human rabies and a case of diphtheria in the United States last year?

When Was the Last Case of Diphtheria?

Yes, diphtheria.

Diphtheria strikes unprotected children.

That’s despite the fact that the diphtheria vaccine has been around for over 100 years, long before it was combined with the first whole cell pertussis vaccine and the tetanus vaccine to form the DPT vaccine.

A vaccine that helped control respiratory diphtheria, which could lead to the formation of a pseudomembrane in a child’s airway, giving diphtheria the nickname of the “strangling angel.”

The last big outbreaks of diphtheria in the United States occurred in the 1970s, although sporadic cases had continued since, albeit at lower and lower levels each year. Eventually, endemic respiratory diphtheria was declared eliminated in 2009.

Still, we know that there have been some recent cases of diphtheria in the United States.

In April of 2014, a teen from Montgomery County, Ohio developed diphtheria.

And again in April of 2018, someone in Oklahoma developed diphtheria.

Why do we care about a few isolated cases?

Because we know how quickly diphtheria can come back if we stop vaccinating our kids!

Just look at what is happening in many other countries that once had these diseases under good control:

  • a 22-year-old unvaccinated women who died in Australia (2011)
  • an unvaccinated 3-year-old who died in Belgium (2016)
  • a family that became infected in South Africa in which at least one child died (August 2017)
  • at least 7 cases of diphtheria in Ukraine (2018)
  • an unvaccinated man in Australia who died (2018)
  • a case in Canada (2018)
  • 8 cases and 3 deaths in Columbia (2018)

Not to mention the large number of diphtheria deaths in Yemen, Venezuela, Haiti, and among Rohingya refugees.

Let’s not bring these diseases back. Vaccines are safe, with few risks, and obviously necessary.

More on the Last Case of Diphtheria

Are the Tdap and DTaP Vaccines the Same Thing?

You have probably already figured out the Tdap and DTaP aren’t the same vaccine, after all, if they were, why would they have different names, right?

Are the Tdap and DTaP Vaccines the Same Thing?

I bet you don’t know the difference between the two vaccines though.

Yes, they both are both combination vaccines that protect against diphtheria, tetanus, and pertussis.

The difference is that one (DTaP) is used as the primary series for infants and younger children (age 6 years and under) and the other (Tdap) is given to older children (age 7 years and above), teens, and adults.

Okay, that’s not the only difference.

The DTaP vaccine actually contains more diphtheria and pertussis antigens than Tdap, which is why it has the capital “D” and “P” in its name. The amount of tetanus toxoid antigens are about the same in both vaccines.

So Tdap contains the same amount of tetanus toxoid, plus a reduced amount of diphtheria and acellular pertussis antigens, as compared to DTaP.

While you would think that older children and adults would get the vaccine with the higher amount of antigens, since they are bigger, that’s not how this works. Vaccines typically start working at the injection site, so body size isn’t a key factor in determining the amount of ingredients.

As a booster dose of vaccine, the lower amount of antigens works just fine and helps reduce the risk of side effects from repeated doses that you might get with higher antigen counts.

More on Tdap vs DTaP

Alternative Names for Vaccine Preventable Diseases

You know all of the names – measles, mumps, rubella, diphtheria, whooping cough, etc.

But do you know why they used to call 10-day measles?

And which disease causes a 100-day cough?

Alternative Names for Vaccine Preventable Diseases

Back in the day, when these diseases were more common, they used much more descriptive terms and nicknames, in addition to their official names.

Why was measles known as 10-day measles?

Because there was also a 3-day measles!

MeaslesRubella
10-day measles3-day measles
red measlesGerman measles
rubeola

Unfortunately, 10-day measles made you feel miserable for 10 days!

Although a vaccine was available, it took a little more time to get measles under better control.

Can you guess which disease was known to cause a 100-day cough?

That’s right, it’s whooping cough or pertussis.

“I honestly felt like it was never going to go away. The doctor told me it was 100 day cough, so I was counting the days while Googling to see if there was anything that could help. I tried everything, you name it, I tried it, and nothing worked. It came to 120 days and I couldn’t understand why it wasn’t gone. I then researched and found that babies take longer to get over whooping cough.”

Fern’s Story – Whooping Cough

Fortunately, the cough doesn’t typically last that long if you are vaccinated and still get pertussis.

What do they call rabies?

Mad dog disease.

But that’s an easy one.

Which disease was known as “the Strangling Angel?”

“The breathing became much more difficult, with a kind of rattling stertor, as if the patient was actually strangling, the voice being exceeding hoarse and hollow, exactly resembling that from venereal ulcers in the fauces. This noise, in speaking and breathing, was so peculiar, that any person in the least conversant with the disease might easily know it by this odd noise; from whence, indeed, the Spanish physicians gave it the name of garrotillo, expressing the noise such make as are strangling with a rope.”

Edward Headlam Greenhow on Diphtheria

How about “The Crippler?”

Fight Polio Poster
Polio, also known as infantile paralysis, was known as “The Crippler.”

The “Speckled Monster?”

Even mild smallpox, as depicted on this WHO Smallpox Recognition Card, included flu like symptoms, a few weeks of pustules, and then waiting for the lesions to scab over...
Even mild smallpox, as depicted on this WHO Smallpox Recognition Card, included flu like symptoms, a few weeks of pustules, and then waiting for the lesions to scab over…

We forget these names, because we don’t see these diseases anymore.

“…for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”

Walter Orenstein

Do you remember that measles was called a “harmless killer?”

Be sure to think about how these now vaccine-preventable diseases got their nicknames before you think about skipping or delaying your child’s vaccines.

More on Alternative Names for Vaccine Preventable Diseases

Is Polio Returning to Venezuela?

Breaking News – further tests have found that the person with suspected polio did not have either wild polio or vaccine-derived poliovirus (VDPV). Could it still be polio? (see below).

Polio is on the verge of being eradicated.

In 2017, there have only been 118 cases of polio in the whole world, including 22 cases of wild poliovirus in Afghanistan and Pakistan and 96 cases of vaccine-derived poliovirus (VDPV) in the Democratic Republic of Congo and Syria.

So far this year, there have only been 15 cases of polio in the whole world, including 10 cases of wild poliovirus in Afghanistan and Pakistan and five cases of vaccine-derived poliovirus (VDPV) in the Democratic Republic of Congo and Nigeria.

Is Polio Returning to Venezuela?

Most of us are aware that vaccine-preventable diseases are just a plane ride away.

We see it, or at least read about it, all of the time, as we continue to see outbreaks of measles affecting our communities.

But polio?

Could polio return?

Venezuela has been polio free for nearly 30 years. The last case of a wild poliovirus infection was in March 1989. And yet ,there are now thought to be at least four cases of poliovirus, type 3 in the Delta Amacuro state of north east Venezuela, where they are also seeing cases of diphtheria and measles.

Report of polio in Venezuela

Among the polio cases is a 2-year-old boy who was unvaccinated, an unvaccinated child who lived next to him, and a partially vaccinated child 8-year-old who lived next door.

“It has been reported unofficially that it is polio vaccine virus.”

Venezuelan Society of Public Health Report

But what is the source of the polio vaccine virus?

We supposedly stopped using oral polio vaccines that can shed in January 2016, right?

Actually, we began the switch from trivalent OPV (tOPV) to bivalent OPV (bOPV) in 2016, removing the the type 2 polio virus that is most likely to cause VAPP. Making sure kids get a dose of IPV first also lowers the risk of VAPP. At least it does when kids get vaccinated according to plan.

“Other children from the same community were vaccinated in April 2018 with oral bivalent polio vaccine.”

PAHO on Epidemiological Update Detection of Sabin type 3 vaccine poliovirus in a case of Acute Flaccid Paralysis 

When did the first case appear? Although we are just hearing about it now, his symptoms began in April, right around the time another child received a bivalent oral polio vaccine.

“No additional AFP cases have been identified to date through active search for AFP cases carried out in the community.”

PAHO on Epidemiological Update Detection of Sabin type 3 vaccine poliovirus in a case of Acute Flaccid Paralysis 

Fortunately, in the past month, no further cases have been identified.

Children in Venezuela are supposed to get at least one dose of IPV (inactivated polio vaccine), followed by four doses of bOPV (bivalent oral polio vaccine).
Children in Venezuela are supposed to get at least one dose of IPV (inactivated polio vaccine), followed by four doses of bOPV (bivalent oral polio vaccine).

So what does this all mean?

For one thing, wild polio isn’t returning to Venezuela. And it doesn’t look like we will see a large outbreak of cVDPV, as there are no further cases of AFP in the area.

But it does illustrate that we can easily see a return of vaccine-preventable disease if we don’t keep vaccinating until they are eradicated. Remember, low vaccination coverage is associated with outbreaks of cVDPV. If everyone is vaccinated and protected, then they won’t get polio, whether it is wild type or shed from someone who was vaccinated.

Latest Updates on AFP in Venezuela

While a Sabin type 3 polio virus had been initially isolated from the stool samples of the unvaccinated 34-month-old boy with polio symptoms, further tests have now been completed.

“Tests carried out by the specialized global laboratory for genetic sequencing have ruled out the presence of both wild poliovirus and vaccine-derived poliovirus (VDPV). The latter- VDPV- is a Sabin virus with genetic mutations that give it the ability to produce the disease. There is no risk of spread to the community or outbreaks of polio from this case.”

PAHO

So what does he have?

The possibilities are non-polio AFP, as many viruses and other diseases can cause polio-like symptoms.

So why did he have the Sabin type 3 polio virus in his stool?

It is well known that the oral polio vaccines shed. Even though he was  unvaccinated, he was likely exposed to others in the community who were recently vaccinated, as it is possible to shed the vaccine virus in your stool. The attenuated (weakened) vaccine virus is unlikely to cause symptoms though, unless it develops the mutations found in VDPV strains, which this one didn’t.

“The child is being further evaluated clinically to determine alternative causes of paralysis. The final classification of the case of acute flaccid paralysis [to define whether or not it is associated with the vaccine] will be based on clinical and virological criteria assessed at 60 days after the onset of paralysis.”

PAHO

So despite what folks are reporting, they didn’t say that this case couldn’t be associated with the polio vaccine. We just know that it is isn’t wild polio and the virus doesn’t have the mutations associated with cVDPV strains, which can not only cause polio symptoms, but can also spread from one person to another, causing outbreaks.

Remember, although the attenuated vaccine virus in the oral polio vaccine is unlikely to cause polio symptoms, it sometimes can, in about 1 in 2.7 million doses.

“VAPP at this time can’t be ruled out, of course, as it’s one of the possibilities.”

Communications Officer
Global Polio Eradication Initiative

Could this child have VAPP?

“A VAPP case was most often defined as a case of acute flaccid paralysis (AFP) with residual paralysis (compatible with paralytic poliomyelitis) lasting at least 60 days, and occurring in an OPV recipient between 4 and 40 days after the dose of OPV was administered, or in a person who has had known contact with a vaccine recipient between 7 and 60–75 days after the dose of OPV was administered.”

Platt et al on Vaccine-Associated Paralytic Poliomyelitis: A Review of the Epidemiology and Estimation of the Global Burden

I guess we will find out in a few weeks, as his symptoms started at the end of April.

Still, remember that VAPP is not contagious.

What to Know About Polio Returning to Venezuela

Several cases of a vaccine strain of polio virus have been found in Venezuela, which is linked to low vaccinated levels.

More on Polio Returning to Venezuela

Updated June 17, 2018

What Are Hypotonic-Hyporesponsive Episodes?

Just about any side effect after a vaccine can be scary for parents.

What if your child suddenly became limp, wasn’t responsive, and was pale?

That would be scary for any parent.

What Are Hypotonic-Hyporesponsive Episodes?

But that’s just what can happen when a child has a hypotonic–hyporesponsive episode (HHE).

“A hypotonic-hyporesponsive episode (HHE) is the sudden onset of hypotonia, hyporesponsiveness, and pallor or cyanosis that occurs within 48 hours after childhood immunizations.”

DuVernoy et al on Hypotonic-hyporesponsive episodes reported to the Vaccine Adverse Event Reporting System (VAERS), 1996-1998

These types of episodes were once thought to happen once for every 1,750 DTP vaccines given.

HHE is much more rare since we switched to a new pertussis vaccine.
HHE is much rarer since we switched to a new pertussis vaccine.

Fortunately, although they certainly do sound scary, the episodes stop on their own and  don’t cause any permanent harm.

Hypotonic-hyporesponsive episodes were even removed as table injuries after DTP back in 1995. It is not that HHE can’t occur after DTP, DTaP, or other vaccines, but rather that HHE doesn’t then cause any permanent neurological damage to the child.

And it is rare for kids to have a second episode, so they can continue to get vaccinated. HHE is not a good reason to skip or delay all of your child’s vaccines. While not a contraindication to getting vaccinated, having an episode of HHE “within 48 hours after receiving a previous dose of DTP/DTaP,” is listed as a precaution to getting another dose of DTaP or Tdap though.

“In general, vaccinations should be deferred when a precaution is present. However, a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction.”

CDC on Vaccine Contraindications and Precautions

Also, HHE has become even more rare since we switched to using DTaP, instead of the older DTP vaccine. So being worried about HHE is definitely not a good reason to skip or delay any vaccines.

What to Know About Hypotonic-Hyporesponsive Episodes

Hypotonic-hyporesponsive episodes were more common after the older DTP vaccines, but still didn’t cause any long term problems and aren’t a good reason to skip or delay your child’s vaccines.

More About Hypotonic-Hyporesponsive Episodes

Diphtheria in Canada

Breaking News – there is a new case of diphtheria in Canada (June 2018), and no, according to health officials, this one is not cutaneous diphtheria.

A lot of people were surprised by the news of a case of diphtheria in Canada last year.

Some folks were quick to blame the anti-vaccine movement, assuming it was in an unvaccinated child.

News soon came that the child was vaccinated!

“I’ve always been on top of that, I’m a firm believer in immunizations.”

Mother of 10-year-old with diphtheria

What happened next?

Anti-vaccine folks began using the fact that he was vaccinated, but still developed diphtheria, as some kind of proof that vaccines don’t work.

The Case of Diphtheria in Canada

They are wrong.

The diphtheria vaccines have worked very well to control and eliminate diphtheria from Canada, just like it has in the United States.

Diphtheria has become rare since the pre-vaccine era.
Diphtheria has become rare since the pre-vaccine era.

So how did a vaccinated child in Canada get diphtheria?

It’s simple.

He has cutaneous diphtheria, not respiratory diphtheria.

What’s the difference?

“Extensive membrane production and organ damage are caused by local and systemic actions of a potent exotoxin produced by toxigenic strains of C. diphtheriae. A cutaneous form of diphtheria commonly occurs in warmer climates or tropical countries.”

Vaccines Seventh Edition

Cutaneous diphtheria occurs on your skin. It is usually caused by non-toxigenic strains of Corynebacterium diphtheriae.

On the other hand, respiratory diphtheria is usually caused by toxigenic strains of Corynebacterium diphtheriae.

Diphtheria strikes unprotected children.The diphtheria vaccine (the ‘D’ in DTaP and Tdap), a toxoid vaccine, covers toxigenic strains. More specifically, it covers the toxin that is produced by toxigenic strains of Corynebacterium diphtheriae. It is this toxin that produces the pseudomembrane that is characteristic of diphtheria.

It was the formation of this pseudomembrane in a child’s airway that gave diphtheria the nickname of the “strangling angel.”

So why the fuss over this case in Canada? They likely don’t yet know if it is a toxigenic strain. If it is, then it could be a source of respiratory diphtheria.

But remember, even if these kids developed an infection with the toxigenic strain of Corynebacterium diphtheriae, those that are fully vaccinated likely wouldn’t develop respiratory diphtheria. Again, it is the toxin that the bacteria produces that cause the symptoms of diphtheria. The vaccine protects against that toxin.

For example, when an intentionally unvaccinated 6-year-old in Spain was hospitalized with severe diphtheria symptoms a few years ago, although many of his friends also got infected, non of them actually developed symptoms because they were all vaccinated.

Diphtheria Is Still Around

Diphtheria is DeadlyTragically though, especially since diphtheria is still endemic in many countries, we are starting to see more and more lethal cases of diphtheria, including cases in many more countries where it was previously under control:

  • at least 142 diphtheria deaths in Venezuela since 2016, among about 1,602 cases
  • at least 85 deaths in Yemen, among about 1,584 cases since 2017
  • at least six deaths among Rohingya refugees in Bangladesh
  • at least two cases of diphtheria in Ukraine
  • a family that became infected in South Africa in which at least one child died (August 2017)
  • an unvaccinated 3-year-old who died in Belgium (2016)
  • a 22-year-old unvaccinated women who died in Australia (2011)

It is even more tragic that diphtheria is not under control in so many more countries.

In 2016, the WHO reported that there were just over 7,000 cases of diphtheria worldwide. While that is down from the 30,000 cases and 3,000 deaths in 2000, thanks to improved vaccination rates, there is still work to be done.

And as this recent case in Canada shows, diphtheria is still around in many more places than we would like to imagine.

Get educated. Vaccines are necessary.

What to Know About Diphtheria in Canada

A case of diphtheria in Canada is a good reminder that vaccines are still necessary.

More on Diphtheria in Canada

Updated on June 25, 2018