Tag: immunizations

Mumps Outbreaks

Pre-Vaccine Era Mumps Outbreaks

In the pre-vaccine era, mumps was a common childhood infection 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

Could this all be because of waning immunity?

2016 Mumps Outbreaks

So far in 2016, the CDC reports that there have been:

  • at least 4,619 cases of mumps
  • cases have been reported in all states except Delaware, Louisiana, Vermont, and Wyoming
  • seven states, AK, IA, IN, IL, MA, NY, and OK with more than 100 cases in 2016

The most recent, ongoing outbreaks are in:

  • Arkansas (at least 2,159 cases) – which may be fueled by a large community of Marshall Islanders living in close quarters, with low levels of vaccinations among adults in the community
  • Oklahoma (at least 324 cases)
  • Washington (93 cases)
  • Long Beach, New York (45 cases), and at State University of New York (SUNY) at New Paltz in New York (13 cases)
  • Harvard University (4 cases)
  • University of Missouri (31 cases)
  • Tufts University (9 cases)
  • 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.

For More Information on Mumps Outbreaks:

References on Mumps Outbreaks:
CDC. Reported Cases and Deaths from Vaccine Preventable Diseases, United States, 1950-2013.

Updated on December 24, 2016

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
  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

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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:

  • 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
  • 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:

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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?

eli-lilly-vaccine
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 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.

So much for 300 new vaccines…

For More Information on New Vaccines:

Maurice Hilleman – The 20th Century’s Leading Vaccinologist

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
  • greatest vaccinologist
  • 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.

Maurice Hilleman also:

  • defined antigenic drift and shift for influenza
  • discovered and purified interferon
  • identified adenovirus
  • discovered SV40

All together, he developed 40  experimental and licensed animal and human vaccines.

Hilleman once called Jenner, Pasteur, Koch, von Behring, Ehrlich and Lister giants of their time – the late 18th and 19th centuries.

Similarly, Maurice Hilleman was, without question, a giant of our time.

For More Information on Maurice Hilleman:

News on the Latest Measles Outbreaks

Breaking News – We already have reports of measles cases in 24 people from 7 states (California, Colorado, Florida, New Jersey, New York, Pennsylvania, and Utah) in 2017. (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

measles-outbreaks
We ended 2014 with 667 measles cases – a record high.

Declaring measles eliminated in the United States didn’t mean that we didn’t have any more measles, after all, it wasn’t eradicated yet. It just that we were 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

While we are still watching the outbreaks in Denver and LA county, 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 did expose 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 the LA county outbreak – a resident of Ventura County.

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

  • at least 24 cases (as of early February)
  • cases in 7 states, including California, Colorado, Florida, New Jersey, New York, Pennsylvania, and Utah
  • 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)
  • a new case in Utah – a resident who had “received all appropriate vaccinations” and developed measles after traveling outside the US

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:

  • 79 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.

For More Information On Measles Outbreaks:

Updated on February 19, 2017

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