Tag: discontinued vaccines

Typhus vs Typhoid Fever

Typhus and typhoid have both been in the news recently.

  • Texas officials issue alert about typhus threat
  • Typhoid: Two children die‚ 60 ill after drinking from contaminated stream in South Africa

Should you start panicking?

Of course not.

Even before they knew which bacteria actually caused typhus and typhoid fevers, they knew they were different diseases.
Even before they knew which bacteria actually caused typhus and typhoid fevers, they knew they were different diseases.

While neither is usually a threat to most people in developed countries, instead of panicking, get educated and learn how you can prevent these still common infections.

Typhus Fever

Epidemic typhus fever is spread by human body lice (not head lice!) that are infected with the Rickettsia prowazekii bacteria.

Symptoms of typhus fever can include the sudden onset of:

  • fever
  • muscle aches (myalgias)
  • headache
  • chills
  • not feeling well (malaise)
  • cough

Some patients develop a characteristic rash made up of small red spots (macules) that start on the upper trunk. It then spreads to the rest of the body, but spares the face, palms, and soles. The rash can eventually become petechial.

Untreated, the fever may last up to two weeks, followed by a slow recovery of two to three months for all of the other symptoms. Typhus fever can be fatal.

Fortunately, treatment is available – the antibiotic doxycycline.

How do you prevent epidemic typhus fever? You avoid body lice. And avoid flying squirrels, which can be infected with Rickettsia prowazekii bacteria.

Is typhus fever vaccine-preventable? No, although a typhus vaccine was once available, it was discontinued in 1979.

Keep in mind that in addition to epidemic typhus, which is now very rare, typhus can also be spread by fleas (murine typhus) and chiggers (scrub typhus).

Murine or endemic typhus is common in tropical and subtropical climates, where it is spread by rats and fleas. In the United States, it is mainly found in California, Hawaii, and Texas, where it has also been associated with cat fleas found on cats and opossums.

Scrub typhus is associated with chiggers in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia.

Typhoid Fever

Although typhus and typhoid some very similar, there are some big differences between these two diseases.

What are they?

Unlike typhus, typhoid fever is:

  • caused by the Salmonella typhi bacteria
  • spread by ingesting contaminated food and water
  • characteristic by symptoms that include a gradual onset of fever, with stomach aches, headache, loss of appetite, and sometimes a rash.
  • still vaccine preventable – in fact, there are two typhoid vaccine, one oral and the other a shot

Fortunately, typhoid fever can be treated with antibiotics, although it is sometimes multi-drug resistant and some people become chronic carriers, even with treatment (Typhoid Mary).

While adventurous and fun, eating street vendor food is probably a good way to get typhoid fever.
While adventurous and fun, eating street vendor food is probably a good way to get typhoid fever. Photo by Sam Sherratt (CC BY-SA 2.0)

That it can still be treated is a good thing, because unlike epidemic typhus, typhoid fever is still very much around.

The CDC estimates that there are about 5,700 cases of typhoid fever in the United States each year, mostly in travelers that leave the country.

Worldwide, there are about 21 million cases of typhoid fever and 222,000 typhoid-related deaths each year!

In addition to getting vaccinated, if traveling to the developing world, to avoid typhoid, you should avoid risky food and be sure to “Boil it, cook it, peel it, or forget it.”

What to Know About Typhus and Typhoid Fever

Typhus and typhoid fevers are two very different diseases that can both be avoided with good hygiene practices.

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Underreporting of Side Effects to VAERS

Vaccine injuries and side effects should be reported to Vaccine Adverse Event Reporting System (VAERS).

Reporting Side Effects to VAERS

The CDC advises that “all significant adverse events that occur after vaccination of adults and children, even if you are not sure whether the vaccine caused the adverse event.”

Are they?

Unfortunately, no.

Vaccine adverse events can be reported to VAERS online or using a downloadable form.
Vaccine adverse events can be reported to VAERS online or using a downloadable form.

 

While both doctors and parents can report these side effects, they don’t always get reported.

Underreporting of Side Effects to VAERS

Still, although reports to VAERS are underreported, they are almost certainly not underreported by as much as some folks believe.

Have you heard the claim that only 1% of serious vaccine reactions are reported to VAERS?

That’s not true.

That claim is based on an old study about drug reactions and was not specific to vaccines.

We also know that underreporting is less common for more severe adverse reactions than for those that are more mild. For example, one study found that up to 68% of cases of vaccine-associated poliomyelitis (a table injury) were reported to VAERS, while less than 1% of episodes of rash following the MMR vaccine were reported.

That’s not to say that only severe or serious adverse reactions should be reported.

But since VAERS watches “for unexpected or unusual patterns in adverse event reports,” it still works even if each and every side effect isn’t reported.

VAERS Works

Reports to VAERS are underreported.

VAERS still works well though.

Again, that’s because VAERS doesn’t need each and every adverse event to be reported for the system to work and to help it identify vaccines that might not be safe.

“Despite its limitations, VAERS effectively detected a possible problem soon after introduction of RRV-TV in the United States.”

Lynn R. Zanardi, et al on Intussusception Among Recipients of Rotavirus Vaccine: Reports to the Vaccine Adverse Event Reporting System

We saw that with the RotaShield vaccine. After nearly 20 years of research, the first rotavirus vaccine was approved by the FDA on August 31, 1998. About seven months later, in March 1999, the ACIP published their formal recommendations that all infants get RotaShield on a three dose schedule, when they are two, four, and six months old.

By June 11, 1999, VAERS had received 12 reports of intussusception related to the RotaShield vaccine and by July 13, its use was temporarily suspended, as the CDC continued to investigate.

Once the CDC announced the temporary suspension, even more reports of intussusception after RotaShield were made to VAERS. Those extra reports likely mean that intussusception was being underreported initially, but it still triggered the temporary suspension and extra studies that eventually got the manufacturer to withdraw the vaccine.

“VAERS is used to detect possible safety problems – called “signals” – that may be related to vaccination. If a vaccine safety signal is identified through VAERS, scientists may conduct further studies to find out if the signal represents an actual risk.”

CDC on How VAERS is Used

Early signals in VAERS also helped detect a very small increase in the risk of febrile seizures among toddlers who got the 2010-11 flu vaccine combined with either Prevnar or a DTaP vaccine.

Also keep in mind that VAERS isn’t the only system that helps to monitor vaccine safety. We also have the Vaccine Safety Datalink project, the Clinical Immunization Safety Assessment Network, and the Vaccine Analytic Unit.

What to Know About Underreporting of Side Effects to VAERS

Even though underreporting of side effects to VAERS is an issue, because VAERS works by looking at early signals and trends, it still works well to identify possible safety problems from vaccines.

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