Texas – with most of the cases in North Texas, including a large outbreak in Johnson County (72 cases) and two other outbreaks linked to four different cheerleading competitions.
At SUNY New Paltz, most of the cases were among the swim team. In addition, 20 unvaccinated students were sent home from school under quarantine until December 3.
In Arkansas, 42 workplaces, 39 schools in six school districts, six colleges and two private schools in Benton, Carroll, Conway, Faulkner, Madison, Pulaski, and Washington counties are seeing most of the cases. A quarantine is in effect, with unvaccinated children being kept out of school for 26 days from the date of exposure or for the duration of the outbreak, whichever is longer.
Many of these outbreaks occur despite many of the cases having had two doses of the MMR vaccine. A third dose is sometimes recommended during these outbreaks.
That doesn’t mean that the MMR vaccine doesn’t work. After all, just compare today’s rates of mumps, even if they are a little higher than we would like, to pre-vaccine levels…
Getting two doses of the MMR vaccine is still the best way to avoid mumps.
There is no general recommendations to get extra shots though.
Keep in mind that the MMR vaccine isn’t just for kids. Adults who didn’t have mumps when they were kids (or who were born before 1957, when most kids got mumps), should make sure they are vaccinated (at least one dose) and protected too.
Sure, it would be hard to push a vaccine that has been discontinued or not even available in the United States, but if your goal was to aggressively push vaccines, how hard would it be to get Big Pharma to start making them available?
That would more than double the number of vaccines that kids would have to get.
Those Times “Vaccine Pushers” Said No To Vaccines
And how come some of the biggest vaccine advocates have been against plans for mass immunizations if they are vaccine pushers?
In addition to Dr. Albert Sabin advising against President Gerald Ford’s plans for universal vaccination against swine flu in 1976, Dr. Paul Offit missed the chance to push the small pox vaccine on us in 2002. He instead advised for a different plan:
Here’s another way to do it. We can make the vaccine. Make sure we understand who’s going to get it, who’s going to be giving it. Then wait, wait for there to be one case of documented smallpox somewhere on the face of this earth and then we can move into vaccinating people, large numbers of people.
Dr. Paul Offit
Dr. Offit, who is routinely called a shameless vaccine pusher by anti-vaccine websites, was the sole member of a CDC vaccine advisory committee to vote against President George Bush’s 2002 plan to vaccinate about 500,000 health care workers against smallpox. He feared that the risks might outweigh the benefits.
Lymerix, a Lyme disease vaccine was discontinued in 2002. Unfortunately, we still don’t have a new replacement Lyme disease vaccine.
Vaccines That Have Been Discontinued
More commonly, a vaccine gets discontinued with little notice, as there are other options to keep kids vaccinated and protected.
Other vaccines that are no longer made, include:
Cervarix – an HPV vaccine that was discontinued in the US in 2016
Comvax – a Hib/Hepatitis B combination – discontinued in 2014
Tetanus toxoid – discontinued 2013
Tripedia – a DTaP vaccine – discontinued 2011
TriHIBit – a DTaP/Hib combination
JE-VAX – discontinued 2005
Attenuvax – measles vaccine
Mumpsvax – mumps vaccine
Meruvax II – rubella vaccine
M-R-Vax – measles and rubella combo
M-M-Vax – measles and mumps combo
Biavax II – rubella and mumps combo
Heptavax-B – the original hepatitis B vaccine
HIB-Vax – the original Hib vaccine
Dryvax – smallpox vaccine
Measles-Smallpox combination vaccine
Diptussis – a diphtheria/pertussis combination (1949-55)
Quadrigen – a DTP/Polio combination (1959-68)
Streptococcus vaccine (1952-88)
Serobacterin – a pertussis vaccine (1945-54)
Rocky mountain spotted fever vaccine (1942-78)
Typhus vaccine (1941-79)
smallpox vaccine (1917-1976)
Most of these vaccines were discontinued because they simply became obsolete.
The Hib-Vax and Heptavax-B vaccines, for example, both use older technology, so these vaccines were discontinued when newer Hib and hepatitis B vaccines were introduced.
And some vaccines are discontinued or are phased out when they get an update:
MMR -> MMR-II (1978)
Prevnar 7 -> Prevnar 13 (2010)
Gardasil -> Gardasil 9 (2014)
Still other vaccines, like Tripedia and TriHIBit, seemed to get discontinued as a business decision. Through mergers, Sanofi Pasteur, Ltd. ended up with two DTaP vaccines. They had their own Daptacel, but also had Tripedia, a vaccine they acquired from Pasteur Merieux. They ended up discontinuing Tripedia.
Merck also stopped making Comvax not because of “any product safety or manufacturing issues,” but rather “as part of its ongoing effort to focus company resources on opportunities that provide the greatest value for customers, patients, and public health…”
Cervarix was discontinued because of low market demand. The competing HPV vaccine, Gardasil, had the much larger market share.
The Texas Department of Health Resources once had a license to make vaccines, including DTP, diphtheria, DT, pertussis, tetanus, Td, and typhoid vaccines since 1950. They completely exited the vaccine market in 1979.
In the 1970s and 80s, dozens of vaccines were discontinued as Miles Inc., Eli Lilly, Parke Davis, and other companies stopped making vaccines.
While that is often downplayed these days, it is important to realize that we used to have much more competition among vaccine manufacturers. For example, in the early 1970s, the DTP vaccine was made by at least 11 different companies! We now have just two that make DTaP. And in many other cases, like for Prevnar, MMR-II, polio, and the chicken pox vaccine, there is just one manufacturer.
Valneva – Japanese encephalitis vaccine (IXIARO), Dukoral cholera vaccine
Of course, there used to be many more.
During the past fifty years, companies devoted solely or primarily to manufacturing vaccines (such as Lederle and Praxis) have been acquired by other pharmaceutical companies; the number of companies making vaccines has decreased from twenty-six in 1967 to seventeen in 1980 and to five in 2004 (GlaxoSmithKline, Sanofi-Aventis, Merck, Wyeth, and Chiron).
Paul Offit, MD
And then there were four…
21st Century Vaccine Industry Changes
Unlike changes in the 1970s, the latest changes in the vaccine industry and among vaccine manufacturers don’t have a lot to do with companies being forced out of business because of lawsuits.
Mergers and consolidation seem to be fueling the changes.
For example, Novartis, recently considered one of the top five pharmaceutical corporations that make vaccines, sold off its vaccine business to CSL Limited and GSK.
CSL Limited then formed Seqirus to produce their flu vaccines.
In other changes:
Pfizer acquired Wyeth in 2008
Chiron Corp became Novartis Vaccines in 2006
Aventis Pasteur and Sanofi merged to become Sanofi Pasteur in 2004
SmithKline Beecham and Glaxo Wellcome merged to become GlaxoSmithKline in 2000
But you don’t really get how big these mergers are until you understand that:
Pasteur Merieux and Aventis merged to become Aventis Pasteur in 1999
Wyeth acquired Lederle Laboratories/Praxis in 1994
Lederle Laboratories and Praxis merged in 1989
Connaught Laboratories was purchased by the French Merieux Institute, forming Pasteur Merieux in 1989
Still other vaccine manufacturers simply stopped making vaccines.
Older Vaccine Manufacturers
What ever happened to these vaccine manufacturers?
Bionetics Research Inc.
Cutter Laboratories – made anthrax vaccine and the Salk polio vaccine that was involved in the Cutter incident. Was bought by Bayer in 1974, but they no longer make vaccines.
Dow Chemical (Pitman-Moore) – got out of the vaccine business in 1977-78 and stopped making 12 vaccines
Eli Lilly – got out of the vaccine business in 1976 and stopped making 14 vaccines
Evans Medical Ltd.
Mich (Michigan Department of Public Health) – once made 8 vaccines
Miles Inc. – exited the vaccine market in 1970 and stopped making 11 vaccines
North American Vaccine, Inc. – was purchased by Baxter International Inc. in 2000, a company that sold off its remaining vaccine business in 2000, including vaccines for meningitis C and tick borne encephalitis. North American Vaccine, Inc. once sold a DTaP vaccine – Certiva.
Organon Teknika Corporation
Parke-Davis – purchased by Warner-Lampert in 1970, but had sold off their flu vaccine division as King Pharmaceuticals, stopping production of 16 other vaccines. King Pharmaceuticals later changed its name to Parkdale Pharmaceuticals and stopped making vaccines in 2002.
Richardson-Merrill – got out of the vaccine business in 1976-78 and stopped making 14 vaccines
Solvay Pharmaceuticals – purchased by Abbott Laboratories in 2010, but Solvay’s flu vaccine business was sold off and their Influvac vaccine is no longer used in the United States
Squibb & Sons – now known as Bristol-Myers Squibb, since their 1989 merger, Squibb used to make vaccines, including Maurice Hilleman‘s first Japanese B encephalitis vaccine
Texas Department of Health Resources – exited the vaccine market in 1979 and stopped making 7 vaccines
University of Illinois – once made the BCG vaccine
Unlike other companies that merged or had their vaccine business sold off, these companies and their vaccines are gone. And some, like Bionetics Research Inc. and Organon Teknika Corporation were acquired by the same companies (ABL). They just don’t make vaccines anymore.
Book – Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver
References on Vaccine Manufacturers:The Children’s Vaccine Initiative: Achieving the Vision. Historical Record of Vaccine Product License Holders in the United States
Pereira,Nuno Sousa. Vaccine Supply: Effects of Regulation and Competition. International Journal of the Economics of Business 18(2):239-271.October 2010
Many of us have heard the news that there are “300 new vaccines in the pipeline.”
Of course, no one really believes that means scientists are out there developing vaccines against 300 separate diseases or that it will mean that kids will some day get 300 more vaccines.
So what does it mean?
Surprisingly, it doesn’t even mean 300 new vaccines in the pipeline anymore. The latest, 2016 update of the Medicines in Development for Vaccines report from the Pharmaceutical Research and Manufacturers of America now states that there are “More Than 250 Vaccines in Development Pipeline.”
To understand what that means, you have to take a look at the vaccines being developed, which include:
124 for infectious diseases
105 for cancers
thirteen for allergies
eight for neurological disorders
seven for other conditions
And even of the 124 vaccines in development or testing for infectious diseases:
36 are to prevent or treat HIV
25 are to prevent influenza, including new nasal flu vaccines
8 are for RSV
8 are for Ebola
So when they talk about “300 vaccines in the pipeline,” remember that even when you consider that only 124 of them are for infectious diseases, of those, 77 are for just 4 different infectious diseases.
The other 47 vaccines in various stages of development include vaccines for CMV, tuberculosis, dengue, Zika, GBS, West Nile virus, Staph, herpes, hepatitis C, E. coli, pseudomonas, malaria, C. diff infections, Shigella, norovirus, anthrax, smallpox, and ricin.
Some others are for infections that you have likely never heard of, including viral hemorrhagic fever, Ross River virus infections, and Venezuelan equine encephalitis.
And unfortunately, only 17 of these infectious disease vaccines are in stage III trials, which means that very, very few are close to seeing the inside of a pediatrician’s office.
Potential New Vaccines
Which vaccines have the greatest potential to be protecting our kids soon?
Based on which vaccines have completed phase III trials and have been submitted for registration to the FDA, the one likely candidate seems to be:
Dengvaxia – a dengue fever vaccine developed by Sanofi Pasteur which has already been approved in Brazil, Mexico, the Philippines, El Salvador and Costa Rica and is on a Fast Tract schedule in the United States
Other vaccines in late development phases include:
Shingrix – a new shingles vaccine
an MMR vaccine from GSK (already available in other countries)
Men Quad TT – a “second generation” meningococcal vaccine
And we may see the combination, pentavalent MenABCW-135Y meningococcal vaccine by 2021.
Do you know who Maurice Hilleman was or what he did?
He once said that:
Preventative medicine, and little else with the possible exception of antibioitcs, has brought about the lengthening of the average human lifespan to the Biblical threescore and ten years. Among the most potent and effective weapons in accomplishing this longevity have been the vaccines.
If you don’t who he is, you will likely be surprised that he is often described as the:
unsung giant of vaccinology
20th century’s leading vaccinologist
greatest scientist of the 20th century
father of modern vaccines
Tragically, he has also recently been described as the MMR vaccine’s forgotten hero.
Even though he developed 8 of the 14 most commonly used vaccines that save at least 8 million lives a year, few people know about him or that he developed the measles, mumps, hepatitis A, hepatitis B, meningitis, pneumonia, Haemophilus influenzae bacteria, and rubella vaccines.
You might even be more familiar with his daughter, as the Jeryl Lynn strain of mumps virus is in the current mumps vaccine. Hilleman developed the mumps vaccine after culturing the virus from his sick daughter, Jeryl Lynn, and then attenuating the virus.
With all he did, it’s not surprising that Bill Gates called Hilleman one of the most influential vaccine heroes.
Breaking News – We already have reports of measles cases in at least 67 people from 11 states (California, Colorado, Florida, Michigan, Minnesota, Nebraska, New Jersey, New York, Pennsylvania, Utah, and Washington) in 2017, including an ongoing outbreak in Minnesota that is now up to 32 cases. Also many reports of measles outbreaks in Europe. (see below)
We have come a long way since the development of the first measles vaccines in the early 1960s…
Pre-Vaccine Era Measles Outbreaks
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
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, 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
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 goes on already, with other measles cases in 2017 including:
at least 67 cases (as of late April)
cases in 11 states, including California, Colorado, Florida, Michigan, Minnesota, Nebraska, New Jersey, New York, 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 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.
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.
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.
the latest cases – three more cases in Minnesota, as the outbreak spreads to the third county – Ramsey County.
How many cases will we end up with this year? It is certainly getting off to a quick start, which could mean a big year for measles, although it is certainly hard to predict what will happen.
2016 Measles Outbreaks
Starting slow, 2016 ended as a fairly average year for measles:
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
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.
International Measles Outbreaks
The endemic spread of measles was stopped or eliminated in 2000. Since then, most of the measles outbreaks in the United States begin when someone travels out of the country, gets sick, and exposes others. Or less commonly, when an international traveler brings measles into the country.
That makes it easy to understand that large outbreaks of measles in other parts of the world could increase the risk that we have more outbreaks here. And that’s what happened in 2014 when there was an epidemic of measles in the Philippines and we ended up with the most cases since 1994, many linked to travel to and from the Philippines.
This year, the world is seeing large outbreaks of measles in:
European Union – Austria (71 cases), Belgium (266 cases), Bulgaria (61 cases, including one death – a 10-month old unvaccinated child), Denmark, France (134 cases, including 2 cases of encephalitis), Germany (410 cases), Hungary (41 cases), Iceland (2 cases. 10-month-old unvaccinated twin siblings), Italy (1,603 cases), Portugal (21 cases, including one death), Spain (35 cases), and Sweden (15 cases). The largest outbreak is in Romania, where there have been 4,793 cases and 21 deaths in the past 13 months.
Switzerland – the Swiss Sentinel Surveillance Network already reports 52 measles cases in 2017, compared to 36 in 2015 and 71 in 2016. Many of the cases are in young adults, aged 20-24 years. There has been one death, a vaccinated man being treated for leukemia.
Australia – 34 cases so far in 2017
Canada – over 30 cases including an outbreak in Nova Scotia (15 cases)
Japan – 139 cases so far in 2017 (they had 5 in April 2016…)
Guinea – a measles epidemic has been declared in the country, with at least 1,527 cases and 2 deaths this year
Indonesia – island of Bali
Republican of South Sudan
These outbreaks are a great reminder to review the special vaccine travel requirements, including that adults who “plan to travel internationally should receive 2 doses of MMR at least 28 days apart,” that infants traveling abroad can get their first dose of MMR as early as age 6 to 11 months, with a repeat dose at age 12 months, and that “children aged who are greater than or equal to 12 months need 2 doses of MMR vaccine before traveling overseas,” even if they aren’t four to six years old yet.