Tag: immunizations

Vaccines and the Latest Autism Prevalence Report

The Autism and Developmental Disabilities Monitoring (ADDM) Network recently released a report that showed a 15% increase in autism prevalence rates.

What does that have to do with vaccines?

Well, nothing, unless you are an anti-vaccine group that is continually trying to associate vaccines with autism.

Trends in Autism Prevalence

Just about everyone understands that autism prevalence rates have been increasing over the years. It is what makes some folks think that there is a real autism epidemic.

Using ADDM Network numbers, it is easy to see the trend:

  • 1 in 150 children in 2000
  • 1 in 150 children in 2002
  • 1 in 125 children in 2004
  • 1 in 110 children in 2006
  • 1 in 88 children in 2008
  • 1 in 68 children in 2010
  • 1 in 68 children in 2012
  • 1 in 59 children in 2014 (the latest, 2018 report of children born in 2006)

As in previous years, this new report generated headlines from anti-vaccine groups, who continue to think that any increase in autism rates is a new reason to blame vaccines.

Of course, as it is has been shown over and over again, vaccines are not associated with autism.

These CDC reports should even take away any last idea that they are.

Why?

If there was any association with vaccines, then why are autism rates so widely different in the 11 states that are tracked by ADDM?

Are immunization rates different in those states?

Autism and Developmental Disabilities Monitoring (ADDM) Network

Anyone who has read the latest report on autism rates understands that it “is not a representation of autism in the United States as a whole, but is instead an in-depth look at the 11 communities in the ADDM Network.”

Those communities have changed for each report, but this time they were in Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin.

key-finding-asd-prevalence
Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014 (2018 report)

Even then, the ADDM Network doesn’t look at all of the children in those states. They are mostly looking at children near large institutions that are hosts for the ADDM Network, such as the University of Arkansas for Medical Sciences, Johns Hopkins University, and Rutgers University, etc.

The 325,483 8-year-olds in the latest ADDM Network report were born in 2006 and live in:

  • part of Maricopa County in metropolitan Phoenix, Arizona
  • 75 counties in Arkansas
  • Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson counties in Colorado
  • Clayton, Cobb, DeKalb, Fulton, and Gwinnett counties in Georgia
  • Baltimore County, Maryland
  • parts of two counties (Hennepin and Ramsey) including the large metropolitan cities of Minneapolis and St. Paul, Minnesota
  • Franklin, Jefferson, St. Charles, St. Louis, and St. Louis City counties in Missouri
  • Essex, Hudson, Union, and Ocean counties in New Jersey
  • Alamance, Chatham, Forsyth, Guilford, Orange, and Wake counties in North Carolina
  • Bedford, Cheatham, Davidson, Dickson, Marshall, Maury, Montgomery, Rutherford, Robertson, Williamson, and Wilson counties in Tennessee
  • Dane, Green, Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Rock, Walworth, and Waukesha counties in Wisconsin

Why is this important?

“Autism prevalence among black and Hispanic children is approaching that of white children,” said Dr. Stuart Shapira, associate director for science at the CDC’s National Center on Birth Defects and Developmental Disabilities. “The higher number of black and Hispanic children now being identified with autism could be due to more effective outreach in minority communities and increased efforts to have all children screened for autism so they can get the services they need.”

It shows that “there continue to be many children living with ASD who need services and support, now and as they grow into adolescence and adulthood.”

Immunization Rates and the Autism and Developmental Disabilities Monitoring Network

It also helps to dispell any last ideas that vaccines are associated with autism…

Just look at the immunization rates in the ADDM Network counties (4 doses of DTaP, 3 doses of IPV, one dose of MMR, 3 doses of Hib, 3 doses of HepB, 1 dose of Varicella, 4 doses of Prevnar, flu shot, and 1 dose of HepA by age 36 months) and compare them to the autism rates in those same counties.

 

County Autism Rate Immunization Rates
Maricopa (AZ) 1 in 71 DTaP 82%, IPV 91%, MMR 90%, Hib 91%, HepB 93%, Var 88%, Prev 75%, flu 32%, HepA 78%
Boulder (CO) 1 in 72 DTaP 87%, IPV 95%, MMR 93%, Hib 89%, HepB 90%, Var 93%, Prev 80%, flu -%, HepA 65%
Jefferson (CO) 1 in 72 DTaP 86%, IPV 93%, MMR 91%, Hib 90%, HepB 94%, Var 90%, Prev 83%, flu 48%, HepA 69%
Cobb (GA) 1 in 59 DTaP 83%, IPV 94%, MMR 91%, Hib 88%, HepB 93%, Var 91%, Prev 80%, flu 40%, HepA 21%
Baltimore (MD) 1 in 50 DTaP 91%, IPV 95%, MMR 95%, Hib 94%, HepB 95%, Var 93%, Prev 86%, flu 46%, HepA 61%
Hennepin (MN) 1 in 42 DTaP 88%, IPV 93%, MMR 92%, Hib 88%, HepB 93%, Var 90%, Prev 82%, flu 42%, HepA 47%
Ramsey (MN) 1 in 42 DTaP 87%, IPV 96%, MMR 93%, Hib 91%, HepB 94%, Var 93%, Prev 79%, flu 42%, HepA 63%
Jefferson (MO) 1 in 71 DTaP 83%, IPV 95%, MMR 90%, Hib 92%, HepB 95%, Var 87%, Prev 82%, flu -%, HepA 51%
Essex (NJ) 1 in 34 DTaP 81%, IPV 91%, MMR 91%, Hib 93%, HepB 91%, Var 91%, Prev 69%, flu -%, HepA -%
Hudson (NJ) 1 in 34 DTaP 78%, IPV 91%, MMR 91%, Hib 92%, HepB 91%, Var 91%, Prev 70%, flu -%, HepA -%
Ocean (NJ) 1 in 34 DTaP 84%, IPV 91%, MMR 91%, Hib 92%, HepB 91%, Var 83%, Prev 74%, flu -%, HepA -%
Union (NJ) 1 in 34 DTaP 89%, IPV 92%, MMR 92%, Hib 91%, HepB 94%, Var 91%, Prev 79%, flu -%, HepA -%
Davidson (TN) 1 in 64 DTaP 89%, IPV 95%, MMR 95%, Hib 93%, HepB 94%, Var 94%, Prev 84%, flu 50%, HepA 35%
Dane (WI)
1 in 71 DTaP 87%, IPV 93%, MMR 93%, Hib 88%, HepB 93%, Var 90%, Prev 82%, flu -%, HepA 45%

If vaccines were associated with autism, what should you see? Higher rates of autism in the areas with the highest immunization rates. You don’t see that in any of this data though, do you?

The counties in New Jersey, with the highest rates of autism, have good immunization rates, but they aren’t much different from the immunization rates in Colorado counties or Arizona counties with much lower autism rates.

Some other things we know about vaccines and the latest autism report?

  • in 2006, when those kids were born, New Jersey had one of the lowest rates for getting newborns a hepatitis B shot on their first day, as recommended, at just 23%. Arizona, with a much lower rate of autism, did much better, getting 65% of newborns their birth dose of hepatitis B vaccine on time. In fact, Maricopa County had one of the highest rates, at 71%.
  • fewer than half of their mothers likely received a flu shot during their pregnancy, even though they had been recommended since the 1990s
  • extremely few of their mothers received a Tdap vaccine during their pregnancy, as this didn’t become a routine recommendation until 2011

Does any of this surprise you?

How can vaccines be associated with autism, when counties that have higher immunization rates have lower rates of autism?

What to Know About Vaccines and the Latest Autism Prevalence Report

The latest Autism and Developmental Disabilities Monitoring (ADDM) Network report on autism prevalence from the CDC shows a rate that has increased to 1 in 59 children. And as county level trends in vaccination coverage show no correlation to those autism prevalence rates, folks will hopefully stop trying to associate vaccines with autism.

More on Vaccines and the Latest Autism Prevalence Report

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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Mumps Outbreaks

Pre-Vaccine Era Mumps Outbreaks

In the pre-vaccine era, mumps was a common childhood disease that could cause orchitis, meningitis, pancreatitis, deafness, and even death.

There were about 212,000 cases a year in the early 1960s, before the first mumps vaccine was licensed in 1968.

Post-Vaccine Era Mumps Outbreaks

Tips to prevent getting sick with the mumps.
A large Ohio mumps outbreak prompted an education campaign to help protect everyone from getting sick.

As with other vaccine-preventable diseases, there was a big drop in cases of mumps once the mumps vaccine was introduced.

In 1968, there were just over 152,000 cases and 25 deaths  and just ten years later, in 1978, that was down to 16,817 cases and 3 deaths.

Once the recommendation for the second dose of MMR came in 1990, it looked like mumps was on it’s way out.

We went from 5,292 cases and one death that year, to just 906 cases and no deaths in 1995. When measles hit its low point of 37 cases in 2004, there were just 258 cases of mumps.

That wasn’t the end for mumps though, as we had some up and down years, including big outbreaks in:

  • 2006 – 6,584 cases among Midwest college students and one death
  • 2008 – only 454 cases, but one death
  • 2009 – 1,991 cases and two deaths
  • 2010 – 2,612 cases mostly among Orthodox Jewish communities and two deaths
  • 2011 – 370 cases
  • 2012 – 229 cases
  • 2013 – 584 cases
  • 2014 – 1,223 cases involving a large outbreak in Ohio and in the NHL
  • 2015 – 1,057 cases mostly among university students in Iowa and Illinois
  • 2016 – 6,369 cases in 46 states (no cases in Delaware, Louisiana, Vermont, or Wyoming), with the most cases in Arkansas, Iowa, Indiana, Illinois, Maine, New York, Oklahoma, and Texas.
  • 2017 – at least 5,629 cases of mumps, with cases in all states except Wyoming and South Dakota. The latest outbreaks are at Syracuse University, in Anchorage, Alaska (many unvaccinated cases), and Hawaii.

Could this all be because of waning immunity?

The herd immunity threshold may need to be higher than the previously suggested 88%–92% to prevent community transmission and outbreaks of mumps.

Quinlisk on Mumps Control Today

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…

Unfortunately, this Syracuse University poster doesn't mention getting vaccinated...
Unfortunately, this Syracuse University poster doesn’t mention getting vaccinated…

And in the biggest outbreak, in Arkansas, only 71% of people were up-to-date on their vaccines!

Of course, getting two doses of the MMR vaccine is still the best way to avoid mumps.

There is no general recommendations to get an extra shot, although a third dose of MMR during an outbreak was recently recommended by the ACIP. The recommendation has not yet been formally approved though.

A recent study that was published in the New England Journal of Medicine, Effectiveness of a Third Dose of MMR Vaccine for Mumps Outbreak Control, found a lower risk of mumps in those who got a third dose of MMR.

Not surprisingly, the study also found a much higher risk of mumps, with the highest attack rates, in those who were unvaccinated or who had just one dose!

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.

Vaccines work. They just aren’t perfect…

And these outbreaks show that they are definitely still necessary. In the latest outbreak in Hawaii, where “has been confirmed in children and adults, both vaccinated and unvaccinated,” there have been at least “16 reports of complications due to mumps infection,” including orchitis and hearing loss.

What to Know About Mumps Outbreaks

Although mumps outbreaks are occurring among those who are vaccinated, you still have a much higher chance of getting mumps if you are unvaccinated and unprotected.

For More Information on Mumps Outbreaks:

Updated on January 7, 2018

Pediatricians as Vaccine Pushers

We often here that pediatricians are vaccine pushers, at least from anti-vaccine folks…

If that is the case though, how come pediatricians don’t routinely push any of the following vaccines on kids:

  1. Adenovirus vaccine – only given to enlisted soldiers during basic training
  2. Anthrax vaccine – high risk people only
  3. BCG vaccine vaccine – high risk people only
  4. Cholera vaccine – recently approved in the United States as a travel vaccine
  5. Hepatitis E – not available in the United States
  6. Japanese encephalitis vaccine – a travel vaccine
  7. Meningococcal C vaccine (MenC) – not available in the United States
  8. Meningococcal B vaccine (MenB) –  has a “permissive” recommendation in that parents are told they can get it if they want their kids to avoid MenB infections, but it is not required yet.
  9. MenHibrix – a combination between Hib and Meningococcal Groups C and Y, but it is only given to high risk kids and was discontinued in the United States because of low demand
  10. Plague vaccine – discontinued
  11. Rabies vaccine – high risk people only
  12. Shingles vaccine – seniors only
  13. Smallpox vaccine – high risk people only
  14. Tick-borne encephalitis – not available in the United States
  15. Typhoid fever vaccine – a travel vaccine
  16. Typhus vaccine – discontinued
  17. Yellow fever vaccine – a travel vaccine
The oral adenovirus vaccine is approved to prevent adenovirus infections in military populations.
The oral adenovirus vaccine is approved to prevent adenovirus infections in military populations.

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.

For More Information on Vaccine Pushers

Updated February 7, 2018

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Discontinued Vaccines

tripedia
The Tripedia DTaP vaccine was discontinued in 2013.

Most people know that the RotaShield rotavirus vaccine was discontinued in 1999 because it was found to be linked to intussusception.

It took eight years for a new rotavirus vaccine to be licensed.

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:

  • Menomume – an older meningococcal polysaccharide vaccine was discontinued in 2017 in the US as it was replaced with the newer meningococcal conjugate vaccines Menactra and Menveo.
  • MenHibrix – a meningococcal – Hib combination vaccine that was discontinued in the US in 2016 due to low demand
  • Cervarix – an HPV vaccine that was discontinued in the US in 2016 due to low demand
  • 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
  • Plague vaccine
  • Poliovax
  • 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.

Orig. Title: SPvac806.8a
A smallpox vaccination kit included the diluent, a vial of Dryvax smallpox vaccine, and a bifurcated needle.

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.

Vaccine Manufacturers and Discontinued Vaccines

And of course, some vaccine manufacturers simply stopped making vaccines.

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.

For More Information on Discontinued Vaccines:

Updated on February 7, 2018

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History of Vaccine Manufacturers

Currently, the main manufacturers of vaccines used in the United States include:

  1. Emergent Biosolutions – Anthrax vaccine
  2. GSK Vaccines – Bexsero, Boostrix, Cervarix, Energix-B, Fluarix, Havrix, Hiberix, Infanrix, Kinrix, Menveo, Pediarix, Rabavert, Rotarix
  3. Mass Biologics (Massachusetts Public Health Biological Laboratories) – made the first DTP vaccine and continues making a generic Td vaccine
  4. MedImmune (owned by AstraZenaca) – FluMist
  5. Merck – Gardasil, MMR-II, PedvaxHIB, Pneumovax23, ProQuad, Recombivax HB, RotaTeq, Vaqta, Varivax, Zostavax
  6. PaxVax – Vivotif typhoid vaccine
  7. Pfizer – Prevnar, Trumenba
  8. Protein Sciences Corporation – Flublok
  9. Sanofi Pasteur – Adacel, Daptacel, Fluzone, Imovax Rabies, Pentacel, IPOL, Pentacel, Menactra, YF-Vax,
  10. Seqirus – Afluria, Fluad, Flucelvax, Fluvirin
  11. 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?

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Eli Lilly used to make a Small Pox vaccine
  • 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
  • Sclavo
  • 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.

For More Information on Vaccine Manufacturers:

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

Vaccines In Development

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

Other vaccines in late development phases include:

  • Shingrix – a new shingles vaccine – NOW Approved
  • 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.

So much for 300 new vaccines…

For More Information on New Vaccines:

Updated January 31, 2018