Tag: Hib

How Can They Make a Vaccine for a Bacteria?

Why do some folks think that you can’t make a vaccine for a bacteria?

How can they make a vaccine for a bacteria?
You have done everything you can to keep her healthy by not vaccinating but sometimes things still happen, like your baby gets a vaccine-preventable disease???

Probably because they spend too much time in anti-vax Facebook groups…

How Can They Make a Vaccine for a Bacteria?

Hopefully most people do know that there are plenty of vaccines for bacteria, from tetanus to tuberculosis and typhoid fever.

Essential oils do not help kids with meningitis.
Essential oils do not help kids with meningitis.

And that several of those vaccines can help prevent children, including infants, from getting meningitis.

Vaccines that prevent bacterial meningitis include:

  • Hib – the Haemophilus influenzae type b bacteria was a common cause of meningitis in the pre-vaccine era
  • Prevnar – the Streptococcus pneumoniae bacteria can cause meningitis
  • Menactra and Menveo – protect against serogroup A, C, W, Y meningococcal bacteria
  • Bexsero and Trumenba – protect against serogroup B meningococcal bacteria

Want to protect your kids from meningitis and help to keep them healthy?

Get them vaccinated.

More on Vaccines for Bacteria

Vaccines for Kids with Asplenia

Asplenia means lack of a spleen or a spleen that doesn’t work.

Although the spleen is an important organ that helps your body fight infections, in addition to other functions, it is certainly possible to live without a spleen.

Asplenia

There are many reasons a child might have asplenia, including:

  • congenital asplenia (children born without a spleen), sometimes associated with severe cyanotic congenital heart disease, such as transposition of the great arteries
  • surgical removal (splenectomy) secondary to trauma or anatomic defects
  • surgical removal to prevent complications of other conditions, such as ITP, hereditary spherocytosis, pyruvate kinase deficiency, Gaucher disease, and hypersplenism, etc.

And some children simply have a spleen that doesn’t work (functional asplenia) or doesn’t work very well because of sickle-cell disease and some other conditions.

Vaccines for Children with Asplenia

Because the spleen has such an important function in helping fight infections, without a spleen, a child is at increased risk for infections.

Specifically, there is a risk for severe infections from the Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis bacteria.

Fortunately, there are vaccines that protect against many subtypes of these bacteria, including:

  • Hib – protects against Haemophilus influenzae type B
  • Meningococcal conjugate vaccines – Menactra or Menveo, which protect against 4 common types of the Neisseria meningitidis bacteria – serogroups ACWY
  • Serogroup B Meningococcal vaccines – Bexsero or Trunemba, which protect against Neisseria meningitidis serogroup B
  • Prevnar 13 – protects against 13 subtypes of Streptococcus pneumoniae
  • Pneumovax 23 – protects against 23 subtypes of Streptococcus pneumoniae

Although Prevnar, Hib, and the meningococcal vaccines (Menactra or Menveo and Bexsero or Trunemba) are part of the routine immunization schedule, there are additional recommendations that can change the timing for when kids get them if they have asplenia.

Some kids need extra protection from vaccines.
Some kids need extra protection from vaccines. Photo by Janko Ferlic.

According to the latest recommendations, in addition to all of the  other routine immunizations that they should get according to schedule, children with asplenia should get:

  • one dose of the Hib vaccine if they are older than age 5 years “who are asplenic or who are scheduled for an elective splenectomy” and have not already vaccinated against Hib. Unvaccinated younger kids should get caught up as soon as possible. In general though, Hib is given according to the standard immunization schedule. This recommendation is about kids who are behind on the shot.
  • two doses of a meningococcal conjugate vaccine, either Menactra or Menveo, two months apart once a child with asplenia is at least two years old and a booster dose every five years. Infants with asplenia can instead get a primary series of Menveo at 2, 4, 6, and 12 months, with a first booster dose after three years, and a second booster after another five years. Older infants can get Menactra at 9 and 12 months, again, with a first booster dose after three years, and a second booster after another five years. While these vaccines are recommended for all kids, those with asplenia get them much earlier than the standard age.
  • either a two dose series of Bexsero or a three dose series of Trunemba, once they are at least 10 years old. The Men B vaccines are only formally recommended for high risk kids, others can get it if they want to be protected.
  • between one to four doses of Prevnar, depending on how old they are when they start and complete the series. Keep in mind that unlike healthy children who do not routinely get Prevnar after they are 5 years old, older children with asplenia can get a single dose of Prevnar up to age 65 years if they have never had it before. Like Hib, this recommendation is about kids who are behind on the shot.
  • a dose of Pneumovax 23 once they are at least two years old, with a repeat dose five years later and a maximum of two total doses. Kids who are not high risk typically don’t get this vaccine.

Ideally, children would get these vaccines at least two to three weeks before they were going to get a planned splenectomy. Of course, that isn’t always possible in the case of the emergency removal of a child’s spleen, in which case they should get the vaccines as soon as they can.

More About Asplenia

In addition to these vaccines, preventative antibiotics are typically given once a child’s spleen is removed or is no longer working well. Although there are no definitive guidelines for all children who have had a splenectomy, many experts recommend daily antibiotics (usually penicillin or amoxicillin) until a child is at least 5 years old and for at least 1 year after their splenectomy.

Other less common bacteria that can be a risk for children with asplenia can include Escherichia coli, Staphylococcus aureus, Salmonella species, Klebsiella species, and Pseudomonas aeruginosa. Vaccines aren’t yet available for these bacteria, so you might take other precautions, such as avoiding pet reptiles, which can put kids at risk for Salmonella infections.

Children with asplenia are at increased risk for severe malaria and babesiosis (a tickborne illness) infections. That makes it important to take malaria preventative medications and avoid mosquitoes if traveling to places that have high rates of malaria and to do daily tick checks when camping, etc.

A medical alert type bracelet, indicating that your child has had his spleen removed, can be a good idea in case he ends up in the emergency room with a fever and doctors don’t know his medical history.

Keep in mind that since there are many different causes of asplenia, the specific treatment plan for your child may be a little different than that described here. Talk to your pediatrician and any pediatric specialists that your child sees.

What to Know about Vaccines for Children with Asplenia

Children with asplenia typically need extra vaccines and protection against pneumococcal disease, Hib, and meningococcal disease.

More about Vaccines for Children with Asplenia

Why Didn’t Everyone Die with Our 1980s Level of Vaccination Rates?

This is actually a real question that someone recently asked:

“Can someone please explain how we survived the 1980s with vaccination rates well below “herd immunity” thresholds and far fewer vaccines? Why didn’t everyone die?”

J.B. Handley

Mr. Handley even provides a nice chart to give his question some context.

Vaccination rates for 2 year old children in 1985.
The chart shows vaccination rates for 2 year old children in 1985.

So why didn’t everyone die?

That’s easy.

While vaccine-preventable diseases can be life-threatening, they certainly don’t kill everyone who gets them. They are not 100% fatal. Well, rabies usually is, but not surprisingly, rabies wasn’t on his little chart…

Deaths from Vaccine-Preventable Diseases, 1985

What else does Mr. Handley miss?

“Comparisons between rates obtained from immunization records versus the total sample (records and recall) conducted on data collected between 1979 and 1983 showed that the USIS, which accepted parental recall, underestimated the true vaccination rate in preschoolers by as much as 23% for some antigens.”

Simpson et al on Forty years and four surveys: How does our measuring measure up?

The vaccination rates he is citing were based on a phone survey that wasn’t thought to be very accurate, underestimating true vaccination rates. It was last used in 1985.

While vaccination rates weren’t great at the time, they just weren’t as horrible as he makes it seem, but we still had some deaths from vaccine-preventable diseases. Not as bad as the pre-vaccine era though, when hundreds of people died with measles each year.

Here’s the data from the CDC for 1985:

https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/E/reported-cases.pdf

  • 23 deaths from tetanus
  • 4 deaths from pertussis
  • 4 deaths from measles
  • 1 death from rubella
  • 2 cases of congenital rubella syndrome

Unfortunately, it got worse. This was just before the large measles outbreaks from 1989 to 1991, when 123 people died. During those three years, there were also 28 deaths from pertussis, 6 deaths from mumps, 13 deaths from rubella and 77 cases of congenital rubella syndrome!

But then we learned our lesson and we got kids vaccinated. But most of the problems then were about access to vaccines, not parents who intentionally skipped or delayed vaccines for their kids.

Deaths from non-Vaccine-Preventable Diseases, 1985

The CDC Morbidity and Motality Weekly Report includes summaries of notifiable diseases in the United States.Many of the diseases on J.B. Handley’s chart weren’t yet vaccine-preventable in 1985. They were quite deadly though, which is why vaccines were being developed and were eventually added to the schedule to protect our kids from getting them.

But in 1985 (*or in the years before the vaccine was introduced), tragically, the CDC lists:

  • 80 deaths from hepatitis A
  • 490 deaths from hepatitis B
  • 68 deaths from chicken pox
  • 219 deaths from Hib meningitis in children and about another 45 deaths from Hib epiglotittis
  • at least 200 deaths from pneumococcal disease in children*
  • 257 deaths from meningococcal infections
  • 20 to 60 deaths each year from rotavirus infections*

Want us to Turn Back the Clock and go back to an immunization plan (the Jenny McCarthy schedule) that didn’t include vaccines against any of these diseases? We would end up back to when kids still died of meningitis, pneumonia, blood infections, severe dehydration, epiglottitis,  Hib, pneumococcal disease, rotavirus, hepatitis A, chicken pox, meningococcal disease, and developed cancer from HPV and hepatitis B infections.

And the answer to Mr. Handley’s question becomes even more obvious.

How did we survive the 1980s with vaccination rates well below “herd immunity” thresholds and far fewer vaccines?

Many people didn’t.

What to Know About Deaths and Vaccination Rates

Poor vaccination rates and fewer vaccines led to more deaths from now vaccine preventable diseases in the mid-1980s.

More on Deaths and Vaccination Rates

Grave Reminders of Life Before Vaccines

Need a reminder of just how serious vaccine preventable diseases can be?

Don’t remember the pre-vaccine era?

That could be why some folks are so quick to think that skipping or delaying vaccines is a safe option for their kids.

Vaccines are necessary.

Without them, we will see even more outbreaks of measles, mumps, and pertussis and kids will continue to die of rabies, tetanus, and other now vaccine-preventable diseases.

The South Park Cemetary was begun in 1891 during a diphtheria epidemic.
A diphtheria cemetery in Wyoming.

Isolation hospitals and pest houses were commonly used to quarantine folks with smallpox.
Isolation hospitals and pest houses were commonly used to quarantine folks with smallpox and other now vaccine-preventable diseases.

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…

People continued to die of smallpox well into the 20th century, even though an effective vaccine was developed in 1796.
People continued to die of smallpox well into the 20th century, even though an effective vaccine was developed in 1796.

In the pre-vaccine era, we had outbreaks of polio, and other, now vaccine-preventable diseases.
Outbreaks of polio would once isolate entire towns, as parents feared their kids would get sick too.

Fight Polio Poster
When was the last time you saw a child with polio?

Before wide use of the Hib and Prevnar vaccines, infants with fever would routinely get spinal taps and you would hope for clear fluid (cloudy fluid could be a sign of a bacterial infection).
Before wide use of the Hib and Prevnar vaccines, younger infants with fever would routinely need spinal taps and you would hope for clear fluid (cloudy fluid could be a sign of a Hib or Strep pneumo infection).

In the pre-vaccine era, Hib caused epiglottitis, meningitis, and pneumonia - all life-threatening diseases that are now prevented by the Hib vaccine.
In the pre-vaccine era, Hib caused epiglottitis, meningitis, and pneumonia – all life-threatening diseases that are now prevented by the Hib vaccine.

Before the 1990s, when the Hib vaccine available, hospitals had an epiglottitis team on call and always available.
Before the 1990s, when the Hib vaccine available, hospitals had an epiglottitis team on call and always available.

News of the Newark kids going to Paris to get Pasteur's rabies vaccine made the front page of the New York Times.
In 1885, several boys from Newark went all of the way to Paris to get Pasteur’s new rabies vaccine, as the disease had always been fatal up until that time.

Even if they survive, kids can lose fingers, toes, or even arms and legs to meningococcemia.
Even if they survive, kids can lose fingers, toes, or even arms and legs to meningococcemia.

Roald Dahl's daughter died of measles in 1962, the year before the development of the first measles vaccine.
Roald Dahl’s daughter died of measles in 1962, the year before the development of the first measles vaccine.

Nationwide, at least 123 people died in the United States during a large measles epidemic from 1989 to 1991, during a time that we had good sanitation, nutrition, and medical care.
Nationwide, at least 123 people died in the United States during large measles epidemics from 1989 to 1991, a time when we had good sanitation, nutrition, and medical care, but some folks weren’t vaccinated and we weren’t yet giving a second dose of MMR.

A papilloma caused by HPV on the vocal cords of a child with recurrent respiratory papillomatosis.
A papilloma caused by HPV on the vocal cords of a child with recurrent respiratory papillomatosis. (CC BY 4.0)

You don't have to go back to the pre-vaccine era to know that pertussis kills.
You don’t have to go back to the pre-vaccine era to know that pertussis kills. Ten infants died in 2010 in California from pertussis infections.

We should never forget what life was like before vaccines.

We should know that vaccine-preventable diseases were rarely mild, natural immunity comes at a cost, and that those who died from smallpox, diphtheria, measles, and polio aren’t around to talk about their experiences on Facebook (survivorship bias).

We should never forget that vaccine-preventable diseases were once big killers, and the only reason some folks have grown to fear the side effects of vaccines more than the diseases they prevent, is because we don’t see those diseases very much any more. If more people skip or delay getting vaccinated, we will though.

immunization-program-stages
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

Vaccines are safe and vaccines work.

Get vaccinated and protected.

Outbreaks of vaccine-preventable diseases belong in the past.

What to Know About Life Before Vaccines

Forgetting the pre-vaccine era and the benefits of vaccines makes folks susceptible to anti-vaccine talking points and scares them away from vaccinating and protecting their kids.

More on Remembering Life Before Vaccines