Tag: History of Vaccines

A History of Measles Outbreaks in United States

We have come a long way since the development of the first measles vaccines in the early 1960s…

Pre-Vaccine Era Measles Outbreaks

Unvaccinated children exposed to measles are quarantined for at least 21 days.
Unvaccinated children exposed to measles are quarantined for at least 21 days.

In the pre-vaccine era, measles was a very common childhood disease.

As it is now, it was also a deadly disease.

In the 1950s, there were 5,487,332 cases (just under 550,000 a year) and 4,950 deaths (about 500 each year).

In 1962, there were 469,924 cases of measles in the United States and 432 deaths.

Post-Vaccine Era Measles Outbreaks

The first measles vaccines were licensed between 1963 and 1965, but it was the first national measles eradication campaign in 1966 that got people vaccinated and measles rates down.

In 1970, there were only 47,351 cases and 89 deaths.

Rates continued to drop until the large outbreaks between 1989 to 1991, when there were 55,622 cases and 123 deaths. The addition of a measles booster shot got measles outbreaks under control again. By 2000, when measles was declared eliminated in the United States, there were just 86 cases and one death.

Post-Elimination Era Measles Outbreaks

Measles cases usually begin increasing in April and May. How many cases will we see this year?
Measles cases usually begin increasing in April and May. How many cases will we see this year?

Declaring measles eliminated in the United States didn’t mean that we didn’t have any more measles, after all, it hasn’t been eradicated yet. It just that we are no longer seeing the endemic spread of measles. Since 2000, all of the latest measles outbreaks have been imported from outside the country, or at least they are started by cases that are imported.

We have seen more than a few records in the post-elimination era, including:

  • the year with the historic low number of measles cases – 37 cases in 2004
  • the year with the largest number of cases since 1994 – 667 cases in 2014
  • the largest single outbreak since the endemic spread of measles was eliminated – 377 cases in Ohio in 2014

In 2015, we got a reminder of how deadly measles can be. Although there have been other measles deaths and SSPE deaths in the past ten years, unlike the 2015 death, they are usually buried in CDC reports and aren’t published in the newspaper.

2017 Measles Outbreaks

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died.
An infant hospitalized during a measles outbreak in the Philippines in which 110 people died. Photo by Jim Goodson, M.P.H.

The first new case of 2017 was an unvaccinated adult in San Luis Obispo County, California who was exposed to international travelers over the holidays. The person exposed others to measles at the Twin Cities Community Hospital emergency department in Templeton while contagious in early January.

The second case of 2017 was related to an LA county outbreak that started at the end of 2016 – a resident of Ventura County.

And it went on, with other measles cases in 2017 including:

  • at least 122 cases
  • cases in 16 states, including California, Florida, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Utah, and Washington
  • an infant in San Luis Obispo County that was too young to be vaccinated and who had contact with an unvaccinated adult with measles
  • one new case in the Los Angeles County outbreak, which is now up to 20 confirmed measles cases (including 18 in LA County), all unvaccinated
  • four new cases in Ventura County, California that are linked to another Ventura County measles case and the LA County outbreak, which is now up to 24 cases
  • a case in Jersey City, New Jersey following international travel who exposed people at multiple places, including a hospital, pharmacy, mall, and on a commuter train
  • an infant in Suffolk County, New York who had been overseas
  • an unvaccinated 7-month-old baby from Passaic County, New Jersey who had been traveling out of the country and may have exposed others at area hospitals (a good reminder that infants who are at least 6 months old should get an MMR vaccine before leaving the country)
  • two cases in Salt Lake County, Utah – which began in a resident who had “received all appropriate vaccinations” and developed measles after traveling outside the US and then spread to another person “who had contact with the first case.” According to the SLCoHD, “One of the two individuals with measles had received one MMR vaccine.”
  • two cases in King County, Washington – a man and his 6-month-old infant, both unvaccinated, developed measles after traveling to Asia, and exposed many others around Seattle, including at a Whole Foods, a sandwich shop, their apartment building, and two Amazon buildings.
  • a confirmed case in Omaha, Nebraska, who exposed people on a Delta flight and multiple places in Douglas and Sarpy counties, including the Bergan Mercy Hospital Emergency Room.
  • a young child in Macomb Count, Michigan who required hospitalized and has been linked to international travel
  • a suspected case at William Allen White Elementary School in Lyon County, Kansas which has led to the quarantine of unvaccinated students for 3 weeks
  • an unvaccinated student at Laguna Beach High in Orange County, California, which led to the quarantine of at least 6 unvaccinated students
  • a staff member at Discovery Academy of Lake Alfred in Florida
  • an unconfirmed case in an infant who attended the College of Staten Island Children’s Center in New York
  • two children in Minnesota without a known source of infection
  • another child in Minnesota – among the three Somali Minnesotans in this outbreak are two children who are just two years old – all of the cases were unvaccinated and two required hospitalization, although the common source is still not known. Vaccine hesitancy has been a problem among the Somali Minnesotans because of Wakefield‘s MMR study.
  • five more unvaccinated children in Minnesota, as the outbreak grows to 8.
  • a confirmed case in North Platte, Nebraska who may have exposed others at a middle school, church youth group, the Great Plains Health Emergency Room, a medical office, and a lab.
  • a resident of Livingston County, Michigan who exposed others at area restaurants and St. Joseph Mercy Brighton Hospital after getting measles on a plane ride with an unvaccinated child
  • another case in Minnesota, bringing the outbreak count to 9 unvaccinated children.
  • three more cases in Minnesota, bringing this outbreak case count to 12, with at least 200 people in quarantine.
  • four possible cases in Nebraska
  • eight more cases in Minnesota, bringing this outbreak case count to 20 young children under age 5 years, and now including an infant under age 12 months.
  • four more cases in Minnesota, bringing this outbreak case count to 24 young children under age 5 years and surpassing the size of the 2011 measles outbreak in the Somali community in the same area, which was also mostly among intentionally unvaccinated children.
  • five more cases in Minnesota, including the first outside of Hennepin County – spreading to nearby Stearns County, bringing this outbreak case count to 29 young children under age 5 years, with only one that was vaccinated.
  • three more cases in Minnesota, as the outbreak spreads to the third county – Ramsey County.
  • more measles (2 new cases) in Minnesota (Hennepin County, Ramsey County, Crow Wing County, and now Le Sueur County), where the ongoing outbreak is up to 66 cases, almost all unvaccinated children and where there has been a call to accelerate the two dose MMR schedule for kids over age 12 months.
  • a teen visiting the United States from India who developed measles and exposed others at a hotel and a hospital in Bergen County, New Jersey and in upstate New York.
  • a child in Maryland who was admitted to Children’s National Medical Center in Washington, D.C.
  • more measles (3 new cases) in Minnesota (Hennepin County, Ramsey County, Crow Wing County, and Le Sueur County), where the ongoing outbreak that has been confirmed to be from the wild type B3 strain is up to 68 cases, almost all unvaccinated children.
  • a case in Pennsylvania who exposed others at a visitor center
  • someone who visited the MIT Museum in Cambridge, Massachusetts.
  • two new cases in Minnesota, ending speculation that the outbreak, now up to 70 cases, was over…
  • one new case in Minnesota, raising the number of cases in this ongoing outbreak to 78 cases.
  • a healthcare worker in New York who is employed by Hudson Headwaters Health Network and also works at a Warren County medical practice.
  • someone in Franklin County, Maine (their first case in Maine in 20 years!) who traveled out of the country and caught measles, returning home and possibly exposing others at a movie theater, restaurant, farmers market, and hospital.
  • A case in Butler County, Kansas. Many remember that one of the largest outbreaks of 2014 was in Kansas.
  • an unvaccinated man who lives in Hennepin County, raising the number of cases in this ongoing outbreak (an outbreak that has already cost over $500,000 to contain and which many hoped would soon be over) that started in March to at least 79 cases. With the new case, the clock starts ticking again and Minnesota will have to wait to see if new cases appear over the next 3 weeks.
  • passengers from 13 states on an American Airlines flight from New York to Chicago were exposed to a person with measles in early July, including a 12-week-old infant who required preventative treatment with immune globulin (IG), as she was too young to be vaccinated.
  • a fully vaccinated resident of Onondaga County, New York who was exposed on a domestic flight, only developed mild symptoms, but did expose others.
  • someone who exposed others at the Penn State University Hetzel Union Building Bookstore and other places in State College, Pennsylvania.
  • a second case in the Wichita, Kansas area, this time in Sedgwick County, with exposures at a church, dental office, elementary school, and multiple stores over at least 3 days.
  • a possible case in Sedgwick County, Kansas, a child too young to be vaccinated who may have been exposed at a church. Three other exposed infants who were too young to be vaccinated and who were considered at risk to get measles in this outbreak received immunoglobulin treatment.
  • a traveler who spent time in Hampton Beach in New Hampshire, exposing others.
  • a 46-year-old male in Ohio that got the disease while traveling internationally.

2017 would have been a mild year for measles, except for the really big outbreak in Minnesota… 79 people got measles, 71 were unvaccinated, more than 500 people were quarantines, and the outbreak cost over $1.3 million to contain.

2016 Measles Outbreaks

Starting slow, 2016 ended as a fairly average year for measles:

  • 83 cases
  • cases in 17 states, including Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Tennessee, Texas, and Utah
  • a large outbreak in Arizona, 23 cases, linked to a private detention center
  • a large outbreak in Shelby County, Tennessee, at least seven cases, including six unvaccinated and one partially vaccinated child
  • an ongoing measles outbreak in Los Angeles County and Santa Barbara County that has been linked to the Los Angeles Orthodox Jewish community
  • a case in Colorado in which an unvaccinated adult traveled internationally and ended up exposing many people “from Dec. 21 to 29, 2016, who was at a wide variety of locations in the Denver-Boulder area,” including an Urgent Care center and the Parker Adventist Hospital Emergency Department

As in other years, many of these outbreaks involved unvaccinated children and adults. One case involved a child at the Yuba River Charter School in California, a Waldorf School with very high rates of unvaccinated children.

2015 Measles Outbreaks

With a large outbreak in California, 2015 got off to a very strong start.

Most concerning, more and more, cases don’t seem to have an source that is easy to find, which could mean that the endemic spread of measles has returned in the United States. So instead of having to travel out of the country or be exposed to someone who got measles with a link to international travel, you could get measles just by going to a ball game, a movie theater, or to Disneyland. That makes it more important than ever to learn how to avoid measles.

Among the 189 measles cases and outbreaks in 2015 were:

  • 113 cases that were associated with a multi-state outbreak that was linked to Disneyland in California. Before it was declared over on April 17, a few unvaccinated travelers also help spread measles from this outbreak to large outbreak in Quebec, Canada. All in all, the outbreak was linked to at least 113 cases in California and an additional 169 cases in Arizona (5), Nebraska (1), Utah (3), Colorado (1), Washington (2), Oregon (1), Mexico (1), and Canada (155).
  • 13 cases, including an adult worker and 12 infants too young to be vaccinated at the KinderCare Learning Center in Illinois.
  • At least 13 cases, all intentionally unvaccinated, in a South Dakota outbreak that started with an unvaccinated adult traveling to India.
  • Five cases in Clallam County, Washington, including four who were not vaccinated, which cost at least $36,000 to contain and led to the death of an immunosuppressed woman.

In addition to these large outbreaks, 2015 also saw a number of quarantines for unvaccinated students, closing of daycare centers, and a recommendation from a California Department of Health state epidemiologist that people who are not vaccinated against measles “avoid visiting Disney” and “crowded places with a high concentration of international travelers, such as airports.”

Other measles cases in 2015 include:

  • A student at UC Berkeley who may have exposed others to measles on a public bus.
  • A confirmed case in Fairbanks, Alaska – their first case in 15 years, who flew in from Seattle (and is probably the King County case discussed below) and may have exposed others at an area Walmart, Home Depot, Walgreens, several supermarkets, the airport, and hospital, etc.
  • A confirmed case in King County, Washington, who may have exposed others in Seattle, including at an area McDonalds, the Baroness Hotel, a drug store, and the Sea-Tac Airport.
  • A confirmed case in Branson, Missouri, a traveler from Asia, who was contagious when visiting the ER, three local businesses, and perhaps his flight to town.
  • A confirmed case in the Washington D.C. area.
  • Another case of measles in Spokane County, Washington – an unvaccinated person that was exposed to the other case in the area.
  • An unvaccinated student from Europe in Boston, Massachusetts who also traveled to Maine and New Hampshire.
  • Another unvaccinated child in St. Lucie County, Florida – bringing the total to five cases in central Florida in what so far looks like two separate outbreaks.
  • Another case in Indian River County, Florida – an unvaccinated child.
  • An unvaccinated adult in Spokane, Washington – the first case in the area since 1994.
  • Two unvaccinated adults in Indian River County, Florida, one of whom contracted measles while traveling out of the country.
  • An unvaccinated 6-year-old in St. Lucie County, Florida who attended Fairlawn Elementary School in Fort Pierce – leading to five unvaccinated students being kept out of school until early May.
  • The first case in Oklahoma since 1997, a case in Stillwater.
  • A case in Florida, a traveler who was contagious while attending a conference at the Gaylord Palms Resort and Convention Center and also in Maimi-Dade, Orange, and Sarasota counties.
  • A new case in Illinois, the 15th – and so far not linked to the other two outbreaks in the state.
  • A student at Princeton University in New Jersey.
  • Another case of measles in the Washington D.C. area, a case without a known source.
  • A case in a student at Elgin Community College in Kane County, Illinois.
  • A hospitalized infant in Atlanta, Georgia.
  • An unvaccinated 1 year old in Jersey City, New Jersey.
  • A traveler in King County, Washington that may have exposed others in Seattle. The unvaccinated visitor is from Brazil, where there was a large outbreak of measles last year (almost 400 cases).
  • At least one more case in Clark County, Nevada and four more possible cases in Southern and Northern Nevada, which led to the quarantine of at least 11 students at the Spanish Springs Elementary School.
  • A case in Franklin County, Pennsylvania.
  • Four cases of measles in travelers, including two international travelers, who visited Florida.
  • A case in Washington D.C.
  • A student at Bard College in Dutchess County, New York, who exposed many people while traveling on an Amtrak train to Penn Station in New York City.
  • An unvaccinated woman in New Castle County, Delaware who had recently traveled out of the country.
  • A case on the University of Minnesota Twin Cities campus in a student that had recently returned from out of the country. Although others were exposed, it is considered to be a “highly immunized” population, so hopefully the outbreak won’t spread.
  • Two more cases in Arizona that are tied to the Disneyland outbreak, including a woman in Phoenix who may have exposed others up to 195 children at the Phoenix Children’s East Valley Center, including a 3-year-old getting chemotherapy for leukemia.
  • An adult in Cook County, Illinois which in not linked to Disneyland.
  • A student at Valley High School in Las Vegas which led to the quarantine of 36 unvaccinated students until early February.
  • Four cases among an unvaccinated family in Kearny, Arizona that is directly linked to the Disneyland outbreak.
  • A child in Sioux Falls, South Dakota that is unrelated to 13 recent cases in the area and which has no link to travel out of the area.
  • A new case in Oakland County, Michigan that is likely linked to the Disneyland measles outbreak, meaning that the outbreak has now spread to include 7 states and 2 countries.
  • A case in Maricopa County, Arizona has been linked to the Disneyland outbreak.
  • A person in Nebraska who could have exposed others in Omaha and Blair, including at the Omaha Children’s Museum.
  • A case in Lane County, Oregon that has been linked to the Disneyland measles outbreak.
  • A resident of Tarrant County in North Texas who developed measles after a trip to India.
  • Another unvaccinated person in Utah with links to the Disneyland outbreak has tested positive for measles, bringing the total in that state to 3 cases.

In addition to the 36 measles cases that have been associated with the Disneyland outbreak, California already has 5 additional measles cases this year with no link to Disney, including cases in Alameda, Orange, and Ventura Counties.

 

For More Information On Measles Outbreaks:

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Vaccine Billboards

Have you heard about the vaccine billboards?

A billboard in Minnesota educates parents about the benefits of the chicken pox vaccine.
A billboard in Minnesota educates parents about the benefits of the chicken pox vaccine.

Good idea, right?

Billboards to educate people about the importance of getting vaccinated and protected certainly do sound like a good idea.

That’s likely why some folks co-opted the idea and has started putting up their own anti-vaccine billboards pushing classic myths and anti-vaccine talking points.

Vaccine Billboards

Would seeing a billboard remind you that vaccines are necessary?

 

A billboard warning about the oversized influence of Hollywood celebrities who are anti-vaccine.
A billboard warning about the oversized influence of Hollywood celebrities who are anti-vaccine appeared by the Denny’s on Sunset Blvd and Van Ness Ave in Hollywood, CA.

Protect your children. Immunise.
A billboard in Australia to boost immunization rates.

HPV Vaccine is Cancer Prevention.
A billboard in Chicago for the HPV vaccine.

Fact: Vaccines save lives.
A billboard in Springdale, Arkansas that encourages passersby to vaccinate.

The best shot is a flu shot.
Flu shot billboard in Chicago.

Get your flu vaccine.
Flu shot billboard in Missouri.
Vaccines Save Lives Get Vaccinated Today

This billboard of the from Immunisation WA was vandalized with graffiti to display the name of an anti-vaccine group.
This billboard from the Immunisation Alliance of WA was vandalized with graffiti to display the name of an anti-vaccine group.

A vaccine billboard in Texas.
A vaccine billboard in Texas.

immunity-bb
Vaccines Save Lives! billboard in San Francisco.

An HPV vaccine billboard in Wisconsin.
An HPV vaccine billboard in Wisconsin.

Need to learn the risks of ignoring these billboards and their advice to get fully vaccinated and protected?

In the pre-vaccine era, we had outbreaks of polio, and other, now vaccine-preventable diseases.
In the pre-vaccine era, we had billboards warning us of outbreaks of polio, and other, now vaccine-preventable diseases.

Get educated and get vaccinated.

Vaccines are safe, vaccines work, and vaccines are necessary.

What to Know About Vaccine Billboards

Vaccine billboards are one way to help educate folks that vaccines are safe and necessary and remind them to get vaccinated and protected.

More on Vaccine Billboards

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.

More on Typhus and Typhoid Fever

Vaccine Timeline and History of Vaccines

Most people are aware of the big historic dates and events related to vaccines.

For example, they might now when Edward Jenner first tested his smallpox vaccine (1798), when the first polio vaccine was licensed by Jonas Salk (1955), or that we just got a Meningococcal B vaccine (2014).

Smallpox was officially declared to have been eradicated in December 1979.
Smallpox was officially declared to have been eradicated worldwide in December 1979.

But few likely now that we have had rabies vaccines since 1885, a flu vaccine since 1945, or that the last case of wild polio in the United States was in 1979.

“It is hard to fully appreciate how vaccines have revolutionized modern medicine. The long schedule of vaccines may seem like a hassle, and rumors about harmful effects unnerve parents. But, the fact is, vaccines have helped save millions and millions of lives. Just a few generations ago, people lived under the constant threat of deadly infectious diseases, like smallpox, polio, and hepatitis.

Let’s look at the greatest infectious scourges of the past 1,000 years and how vaccines have mitigated or even eradicated the danger.”

Public Health Understanding Vaccines

From historical safety concerns, like the Cutter Incident in 1955 or the withdrawal of the first rotavirus vaccine in 1999, to improvements in vaccine safety and the control, elimination, and eradication of vaccine-preventable diseases, understanding the history of vaccines can help you get educated and understand that vaccines work and that they are safe and necessary.

Early History of Vaccination

In the early history of vaccination we had the the smallpox vaccine and the beginning of the pre-vaccine era – the first vaccines.

  • Lady Mary Wortley Montagu brings variolation to England to prevent smallpox
  • George Washington mandated that every soldier in the Continental Army had to be inoculated against smallpox
  • Edward Jenner conducts experiments in 1796 that led to the creation of the first smallpox vaccine a few years later and replaces variolation as a preventative for smallpox
  • *Dr. Luigi Sacco becomes the Jenner of Italy
  • James Madison, one of the Founding Fathers, signed the Vaccine Act of 1813 – An Act to encourage Vaccination.
  • a vaccine for rabies is developed by Louis Pasteur in 1885
  • vaccines for cholera and typhoid were developed in 1896 and a plague vaccine in 1887
  • the first diphtheria vaccine is developed in about 1913 through the work of Emil Adolf Behring, William Hallock Park, and others
  • the first whole-cell pertussis vaccines is developed in 1914, although it will take several decades before they are more widely used
  • a tetanus vaccine is developed in 1927
  • 12 children die when a multi-use bottle of diphtheria vaccine that didn’t contain a preservative became contaminated with bacteria in the Queensland Disaster in 1928
  • Max Theiler develops the first yellow fever vaccine in 1936
  • the AAP formally approves the use of a pertussis vaccine created by Pearl Kendrick and Grace Eldering in 1943
  • the first flu vaccine is licensed for use in the US in 1945

End of the Pre-Vaccine Era

In the mid-20th century, we started to get vaccines to control diseases that many of us have never seen, like polio, measles, and rubella.

  • the individual diphtheria, tetanus, and pertussis vaccines become combined in a single DTP vaccine in 1948
  • the last smallpox outbreak in the United States kills one person, Lillian Barber, in the Rio Grande Valley of South Texas in 1949
  • the Salk inactivated polio vaccine (IPV) is introduced in 1955
  • President Dwight D Eisenhower signed the Polio Vaccination Assistance Act in 1955, which gave $30 million in federal grants to states to cover the costs of planning and conducting polio vaccination programs, including purchasing polio vaccine
  • about 200 children develop polio in 1955 from contaminated polio vaccines in what becomes known as the Cutter Incident
  • the live, oral Sabin polio vaccine (OPV) replaces the Salk polio vaccine in 1962
  • President John F Kennedy signed the Vaccination Assistance Act in 1962 (Section 317 of the Public Health Service Act), which started as a three year program to help get kids vaccinated against polio, diphtheria, tetanus, and pertussis, but it has been continuously reauthorized ever since
  • the first live measles vaccine was licensed in 1963 but was replaced with a further attenuated measles virus that caused fewer side effects in 1968
  • President Lyndon B Johnson established a legacy of US leadership in global immunization by funding the CDC Smallpox Eradication program in 1965
  • the MMR vaccine becomes available in 1971, combined the vaccines for measles, mumps (licensed in 1967), and rubella (1969), and was routinely given when toddlers were about 15 months old
  • routine vaccination with smallpox vaccines end in the US in 1972

The Vaccination Era

The end of the 20th century brought more vaccines and protection against even more now vaccine preventable diseases.

  • Pneumovax, the first pneumococcal vaccine that protects kids and adults from certain types of Streptococcus pneumoniae bacteria is approved in 1971 and is given to high-risk kids
  • President Jimmy Carter’s  National Childhood Immunization Initiative in 1977 reached its goal of immunizing 90% of children
  • the Thirty-Third World Health Assembly declares that smallpox is eradicated in 1979
  • Menomune, the first meningococcal vaccine is licensed in 1981 and is recommended for high-risk kids until it is later replaced by Menactra
  • a plasma-derived hepatitis B vaccine is licensed in 1981
  • Vaccine Roulette, a controversial news segment, airs in 1982 and attempts to associate the DPT vaccine with permanent brain damage, downplays the risks of pertussis disease and helps start much of the modern American anti-vaccine movement
  • a Haemophilus b capsular polysaccharide vaccine is licensed in 1985, but unfortunately does not provide good protection in kids younger than 18 to 24 months, who are most at risk for Haemophilus influenzae Type b disease
  • a recombinant hepatitis B vaccine (Recombivax HB) is approved in 1986 but is only recommended to be used in those at high risk for infection
  • another hepatitis B vaccine, Engerix-B, is approved in 1989
  • the first Haemophilus b conjugate vaccine (PRP-D) is approved in 1988 to provide protection against Haemophilus influenzae type b disease in all kids at least 18 months old, but in 1990, they are replaced with two improved Hib conjugate vaccines (PRP-HbOC and PRP-OMP) that can be given to infants as young as two months old
  • a booster dose of MMR is first recommended in 1989, but only for kids who live in counties that have at least 5 cases of measles. The routine 2 dose MMR schedule wasn’t put into use for all kids until 1994.
  • the Vaccine Adverse Events Reporting System (VAERS) is established in 1990
  • the hepatitis B and Hib vaccines are recommended for all infants in 1991
  • after year’s of neglect under President Reagan, President George HW Bush’s immunization action plan in 1991 once again raised immunization rates following three years of measles outbreaks
  • the DTaP vaccine, which is supposed to have fewer side effects than DTP is licensed, and by 1997 replaces DTP for all required doses, although DTP is never actually shown to have caused seizures or brain damage, as was once claimed in Vaccine Roulette
  • President Bill Clinton’s Childhood Immunization Initiative in 1993 includes signing the Vaccines for Children (VFC) Act, providing free vaccines to many children
  • the WHO declares that polio has been eliminated from the Western Hemisphere in 1994
  • a vaccine to protect kids against chicken pox (Varivax) is licensed in 1995
  • VAQTA, the first hepatitis A vaccine is approved by the FDA in 1996 for kids who are at least two years old, but is mainly given to kids at high risk to get hepatitis A
  • the Salk inactivated polio vaccine (IPV) is once again recommended for kids and replaces the oral polio vaccine (OPV) in 1996 because of a small risk of vaccine-associated paralytic poliomyelitis (VAPP), beginning with a sequential IPV-OPV vaccine schedule and then going to an all IPV schedule in 2000
  • RotaShield, the first rotavirus vaccine is licensed in 1998 but is soon withdrawn from the market in 1999 after it is associated with an increased risk of intussusception, a form of bowel obstruction
  • LYMErix, a Lyme disease vaccine, is licensed in 1998
  • Dr. Andrew Wakefield publishes a report in the journal Lancet and attempts to link the MMR vaccine to autism
  • thimerosal is removed from the vast majority of vaccines in the childhood immunization schedule in 1999 and 2000
  • endemic measles is declared eliminated in the United States in 2000
  • Prevnar, a newer pneumococcal vaccine is licensed in 2000 and is added to the immunization schedule the next year
  • LYMErix goes off the market because of insufficient sales in 2002
  • Flumist, a live, intranasal flu vaccine, is approved in 2004
  • endemic rubella is declared eliminated in the United States in 2004
  • a flu shot for all healthy children between 6 and 23 months became a formal recommendation for the 2004-05 flu season.
  • beginning in the 2004-05 flu season, a flu shot is recommended for women who will be pregnant during flu season, in any trimester, which is different than previous recommendations for a flu vaccine if a women was going to be beyond the first trimester of pregnancy during flu season. Unfortunately, even though they are in a high-risk category, only about only 13% of pregnant women received a flu vaccine in 2003.
  • Havrix, another hepatitis A vaccine, is approved in 2005 and the age indication for both hepatitis A vaccines is lowered to 12 months.
  • Menactra, a vaccine to protect against certain types of meningococcal disease is licensed in 2005 and is added to the immunization schedule in 2006, being recommended for all at 11 to 12 years of age or when they enter high school
  • the Tdap vaccine (Boostrix or Adacel) is recommended for teens and adults to protect them from pertussis in 2006 and replaces the previous Td vaccine that only worked against tetanus and diphtheria
  • RotaTeq, another rotavirus vaccine, is licensed in 2006, and is added to the immunization schedule in 2007
  • the hepatitis A vaccine is added to the routine childhood immunization schedule in 2006
  • Gardasil, the first HPV vaccine, is approved in 2006
  • a shingles vaccine, Zostavax, is approved for adults in 2006
  • a 2nd booster dose of the chicken pox vaccine is added to the immunization schedule in 2007 to help prevent breakthrough infections

The Post Vaccination Era

Why call it the post-vaccination era?

It has been some time since a vaccine for a new disease has been added to the routine vaccination schedule, but we are also starting to see more and more outbreaks of old diseases, especially pertussis, mumps, and measles.

  • another rotavirus vaccine, RotaRix, is approved in 2008
  • another HPV vaccine, Cervarix, is approved in 2009
  • another meningococcal vaccine, Menveo, is approved in 2010
  • a newer version of Prevnar, which can provide coverage against 13 strains of the pneumococcal bacteria, is approved and replaces the older version (Prevnar 7) in 2010
  • Fluzone Intradermal and Fluzone High-Dose are two new flu vaccine options that became available in 2011
  • a combination vaccine that protects against both Haemophilus influenzae type b and Neisseria meningitidis serogroups C and Y was approved by the FDA in 2013. MenHibrix is recommended for infants at high risk for meningococcal disease.
  • Quadrivalent flu vaccines, which protect against four strains of flu, become available for the 2013-14 flu season
  • Trumenba, the first vaccine to protect against serogroup B Meningococcal disease is approved by the FDA (October 2014). Previously, Bexsero, a MenB vaccine that is approved in some other countries, was given to some college students during outbreaks under the FDA’s expanded access program for investigational products. Both are now recommended by the ACIP for those at increased risk for meningococcal serogroup B infections.
  • Gardasil 9 is approved by the FDA (December 2014) to provide protection against five additional types of HPV.
  • Cervarix is discontinued in the US in 2016 because of poor sales
  • Vaxchora is approved to in 2016 for adults traveling to cholera-affected areas
  • MenHibrix is discontinued in the US in 2016 because of low demand
  • Menomune is discontinued in the US in 2017 as it was long ago replaced by the new meningococcal vaccines Menactra and Menveo

More Information About Vaccine Timelines

Updated February 7, 2018

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Hedda Get Bedda Doll and Other Measles Stories

Hedda Get Bedda originally came with a hospital bed.
The Hedda Get Bedda doll originally came with a hospital bed.

In the early 1960s, the American Character Doll Company produced a series of Whimsie dolls, including:

  • Annie the Astronut
  • Fanny the Flapper
  • Hilda the Hillbilly
  • Lena the Cleaner (baseball)
  • Samson the Strongman
  • Simon the Degree
  • Wheeler the Dealer (casino dealer)
  • Zero the Hero

Hardly politically correct for our times, the stereotyped dolls do provide a look at the history of their time.

One other doll, Hedda Get Bedda, is especially helpful in that sense.

Made in 1961, this Whimsie doll could change her face, letting you know how she was feeling when you turned the knob on her head. She could go from having a sleeping face, to a sick face (perhaps having chicken pox or measles), to a happy face (once you made her better).

Does the fact that she also came with a hospital bed mean anything?

Just like some anti-vaccine folks like to think that the simple fact that they made a doll that had measles or chicken pox could possibly mean that they looked at them as mild diseases, you could just as easily say that including the hospital bed means ‘they’ understand they were life-threatening diseases that could put land you in the hospital.

We are talking about the pre-vaccine era after all, and in 1961, and when the Hedda Get Bedda doll came out, there were about 503,282 cases of measles in the United States and 432 measles deaths.

Like the Brady Bunch measles episode, the Hedda Get Bedda doll is sometimes used to push the myth that vaccine-preventable diseases aren’t that serious, helping folks justify their decisions to intentionally skip or delay vaccines and leaving their kids unprotected.

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

Walter Orenstein, MD

For example, if you believed that measles, chicken pox, or Hib were mild diseases, then you might feel better about not getting your child the MMR, chicken pox, or Hib vaccines.

Sure, many people get measles and do get better without any complications. On their way to getting better though, even they have high, hard to control fever for 5 to 7 days, with coughing and extreme irritability.

But while most get better, we shouldn’t forget that some people don’t survive measles without complications. Natural immunity sometimes comes with a price, from vision problems and permanent hearing loss to brain damage.

And tragically, some people don’t get to survive measles.

Get Educated. Get Vaccinated.

For More Information and Measles Stories

US Presidents and Vaccines

You would think that getting kids vaccinated and protected against vaccine-preventable diseases would be a non-partisan issue, but it unfortunately isn’t always the case.

donald-trump

Even before Donald Trump brought up false claims that vaccines cause autism, we have seen what can happen when funding for vaccines dropped. Federal support for vaccines dropped while Reagan was in office and we quickly saw outbreaks of vaccine-preventable diseases, including many deaths.

Fortunately, most American Presidents have strongly supported vaccines.

There is no longer any reason why American children should suffer from polio, diphtheria, whooping cough, or tetanus. … I am asking the American people to join in a nationwide vaccination program to stamp out these four diseases.

JFK in 1962

  • George Washington – had smallpox and later mandated that every soldier in the Continental Army had to be inoculated against smallpox
  • John Adams – was innoculated against smallpox (before Jenner‘s vaccine was available), as were his wife and children
  • Thomas Jefferson – conducted his own smallpox vaccine trials
  • James Madison – signed the Vaccine Act of 1813 – An Act to encourage Vaccination.
  • James K Polk – died of cholera, a now vaccine-preventable disease, three months after his term ended
  • Zachary Taylor – died of cholera while still in office
  • Abraham Lincoln – developed smallpox while he was in office
  • Franklin D Roosevelt – had polio and founded the National Foundation for Infantile Paralysis, which was later renamed the March of Dimes, and helped fund Jonas Salk‘s research on the first polio vaccine
  • Harry S Truman – had diphtheria as a child, which may have left him with vision problems, and was vaccinated against smallpox
  • Dwight D Eisenhower – signed the Polio Vaccination Assistance Act in 1955, which gave $30 million in federal grants to states to cover the costs of planning and conducting polio vaccination programs, including purchasing polio vaccine
  • John F Kennedy – signed the Vaccination Assistance Act in 1962 (Section 317 of the Public Health Service Act), which started as a three year program to help get kids vaccinated against polio, diphtheria, tetanus, and pertussis, but it has been continuously reauthorized ever since
  • Lyndon B Johnson – established a legacy of US leadership in global immunization by funding the CDC Smallpox Eradication program in 1965 (smallpox wasn’t eradicated until 1980)
  • Richard Nixon – observed that scientists who helped develop the polio vaccine with Jonas Salk “deserve far greater respect and support by the people whom they serve than they now receive.”
  • Gerald Ford – instituted a swine flu vaccination program for an outbreak that never appeared
  • Jimmy Carter – his National Childhood Immunization Initiative in 1977 reached its goal of immunizing 90% of children
  • Ronald Reagan – signed the National Childhood Vaccine Injury Act (NCVIA) of 1986, which created VAERS and the NVICP, while federal support for vaccine programs reached a low point in his years in office, as rates of children living in poverty and without health insurance increased
  • George HW Bush – his immunization action plan in 1991 once again raised immunization rates following three years of measles outbreaks
  • Bill Clinton – his Childhood Immunization Initiative in 1993 which included signing the Vaccines for Children (VFC) Act, provided free vaccines to many children
  • George W Bush – announced a major smallpox vaccination program in 2002, but very few healthcare workers actually volunteered to get vaccinated
  • Barack Obama – declared the 2009 H1N1 swine flu outbreak a national emergency, Obamacare requires health insurance plans to pay for vaccines without co-pays, made the Ebola outbreak a national security priority, and helped keep funding for Zika vaccine research going

What can we expect our next President to do about vaccines and vaccination rates?

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Founding Fathers on Vaccines

The Founding Fathers presenting a draft of the Declaration of Independence.
The Founding Fathers presenting a draft of the Declaration of Independence. By John Trumbull – US Capitol

What did the Founding Fathers think about vaccines?

While some folks like to claim that the Founding Fathers would have been against vaccines, most experts think that claim is nonsense.

What we know is that the seven key Founding Fathers, which include:

  • John Adams – was innoculated against smallpox (before Jenner‘s vaccine was available), as were his wife and children
  • Benjamin Franklin – was vaccinated and regretted not vaccinating his own son, who died of smallpox
  • Alexander Hamilton – supported George Washington’s plan to inoculate the Continental Army against smallpox
  • John Jay – having a brother and sister that were both blinded by natural smallpox infections, you would expect that he would be in favor of vaccinations and he did indeed inoculate his own children Maria, Nancy and Sally Jay against smallpox
  • Thomas Jefferson – conducted his own smallpox vaccine trials
  • James Madison – signed the Vaccine Act of 1813 – An Act to encourage Vaccination.
  • George Washington – had smallpox and later mandated that every soldier in the Continental Army had to be inoculated against smallpox

Without speculating on what they would have thought of today’s immunization schedules and anti-vaccine movements, it is safe to say that they supported the use of the vaccines that were available to them at the time to protect themselves and their families.

For More Information on the Founding Fathers and Vaccines: