Tag: meningococcal outbreaks

When You Ask for Vaccine Advice in an Anti-Vaccine Facebook Group…

Can you guess what happens when you ask for advice about vaccines in an anti-vaccine Facebook Group?

Meningitis is not a side effect of vaccines.

What could go wrong?

When You Ask for Vaccine Advice in an Anti-Vaccine Facebook Group…

While most of us are used to hearing about meningococcal meningitis being a big risk for teens and young adults, it is important to realize that rates of disease are also high for infants, with a second peak during adolescence.

The highest rates of meningococcal disease occurs during infancy and adolescence.

So why don’t we routinely vaccinate infants against meningococcal disease?

Many countries do, including Australia and the UK, and in the United States, high risk infants are vaccinated against meningococcal disease.

If you were on the fence but were advised by your paediatrician (Australian spelling) to get vaccinated and protected because a child in your town had just died, would you get vaccinated?

Or would you listen to folks in an anti-vaccine Facebook group who tried to convince you that meningitis was actually a side effect of getting vaccinated?

Folks who insist that deaths from vaccine-preventable disease aren’t real and that instead, they are actually vaccine-injuries?

We know what happens when you ask for vaccine advice in an anti-vaccine Facebook group. The members push their propaganda to scare you away from vaccinating and protecting your kids.

Don’t listen to them. Vaccines are safe and necessary.

More on When You Ask for Vaccine Advice in an Anti-Vaccine Facebook Group…

Vaccine-Preventable Diseases – Year in Review 2018

Does it seem like we are moving in the wrong direction?

The eradication of smallpox shows just what vaccines can do!
The eradication of smallpox shows just what vaccines can do!

No, smallpox isn’t coming back, but many other vaccine-preventable diseases are.

Vaccine-Preventable Diseases – Year in Review 2018

With the availability of new vaccines and the expanded use of other vaccines, many of us were hopeful of the progress that was being made against vaccine-preventable diseases so far this decade.

Remember, it was just four years ago that the WHO certified India as a polio free country. And after years of declining numbers of wild polio cases, 2018 will be the first year with a higher number of cases than the previous year.

This hasn’t been a good year for measles either. The WHO Region of the Americas has lost its status as having eliminated measles!

In Bolivarian Republic of Venezuela, endemic transmission of measles has been re-established, with spread to neighbouring countries. As a result, the Region has lost its status as having eliminated measles. The Regional Technical Advisory Group, which met in July 2018, emphasized the importance of Regional action and an urgent public health response to ensure re-verification of measles elimination in Bolivarian Republic of Venezuela.

Meeting of the Strategic Advisory Group of Experts on Immunization, October 2018 – Conclusions and recommendations

After years of declining rates, global measles cases and deaths began to jump in 2017, a trend that continued in 2018.

“Outbreaks in North America and in Europe emphasize that measles can easily spread even in countries with mature health systems. Due to ongoing outbreaks, measles is again considered endemic in Germany and Russia.”

2018 Assessment Report of the Global Vaccine Action Plan

And no, this isn’t just a problem in other parts of the world.

Vaccine preventable diseases are just a plane ride away.
Vaccine preventable diseases are just a plane ride away.

More cases in other parts of the world mean more cases in the United States because unvaccinated folks travel out of the country and bring these diseases home with them, getting others sick.

But it wasn’t just measles outbreaks, including the second largest number of cases in 22 years, that we were seeing in 2018:

  • chicken pox – although the 41 cases involving a North Carolina Waldorf school got the most attention, there were at least 6,892 cases of chicken pox last year, which continues to trend down from recent highs of over 15,000 in 2010
  • hepatitis A – clusters of outbreaks in 15 states with at least 11,166 cases, many deaths, with exposures at popular restaurants
  • mumps – from recent highs of over 6,000 cases the last few years, we were “back down” to just over 2,000 mumps cases in 2018
  • pertussis – cases were also down in 2018, with a preliminary count of about 13,439 cases last year
  • meningococcal disease – isolated outbreaks continued last year, with cases at Smith College, Colgate University, and San Diego State University

And of course, we had one of the worst flu seasons in some time last year, with 185 pediatric flu deaths.

Fortunately, there were no cases of diphtheria, neonatal tetanus, polio, or congenital rubella syndrome. At least not in the United States.

Why are some disease counts down when so many folks say the anti-vaccine movement is more active than ever?

Remember, the great majority of people vaccinate and protect their kids!

And vaccines work!

It is best to think of the anti-vaccine movement, which has always been around, as a very vocal minority that is just pushing propaganda to scare parents away from vaccinating and protecting their kids.

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad these diseases are, allow themselves to be influenced by anti-vaccine propaganda, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

Also remember that many of these diseases occurred in multi-year cycles in the pre-vaccine era. When an up year hits a cluster of unvaccinated kids, we get bigger outbreaks. And then more folks get vaccinated, starting the cycle all over again. At least until we finally get the disease under better control or finally eradicated.

Want to avoid getting a vaccine-preventable disease this year?

Get vaccinated and protected and encourage everyone else to get vaccinated too.

More on Vaccine-Preventable Diseases – Year in Review 2018

Is the Meningococcal Vaccine More Dangerous Than Meningococcal Disease?

No one who has ever seen a child with meningococcal disease would ever think that it was even remotely possible that getting a meningococcal vaccine was more dangerous than getting the disease.

“The case-fatality ratio of meningococcal disease is 10% to 15%, even with appropriate antibiotic therapy. The case-fatality ratio of meningococcemia is up to 40%. As many as 20% of survivors have permanent sequelae, such as hearing loss, neurologic damage, or loss of a limb.”

Epidemiology of Vaccine Preventable Diseases (PinkBook)

Of course, that doesn’t stop anti-vaccine folks from spreading misinformation about these vaccines to try and scare parents away from vaccinating and protecting their kids.

Is the Meningococcal Vaccine More Dangerous Than Meningococcal Disease?

We actually vaccinate against meningitis with many different vaccines, including Hib, Prevnar, MMR, and the meningococcal vaccines.

And there are different types of meningococcal vaccines, including those that protect against Neisseria meningitidis serogroups A, C, W, Y and Men B.

Meningococcal vaccines are safe and effective against meningococcemia and meningococcal meningitis, both terrible diseases.
Meningococcal vaccines are safe and effective against meningococcemia and meningococcal meningitis, both terrible diseases.

So routine vaccinations likely prevent up to 500 meningitis deaths each year, just in the United States, including many deaths from Hib meningitis, pneumococcal meningitis, and meningococcal disease.

“During 2005-2011, an estimated 800-1,200 cases of meningococcal disease occurred annually in the United States, representing an incidence of 0.3 cases per 100,000 population.”

Epidemiology of Vaccine Preventable Diseases (PinkBook)

What about the idea that 1 in 100 people will have a serious reaction to the vaccine?

“The most frequently reported adverse events for MenACWY-D include fever (16.8%), headache (16.0%) injection site erythema (14.6%), and dizziness (13.4%). Syncope was reported in 10.0% of reports involving MenACWY-D. Of all reported MenACWY-D events, 6.6% were coded as serious (i.e., resulted in death, life-threatening illness, hospitalization, prolongation of hospitalization, or permanent disability). Serious events included headache, fever, vomiting, and nausea. A total of 24 deaths (0.3%) were reported.”

Epidemiology of Vaccine Preventable Diseases (PinkBook)

The serious events listed above were from the clinical trials for the vaccine and didn’t differ between the vaccine and placebo.

Although meningococcal vaccines can have frequent mild side effects, they very rarely have serious side effects.

Not everything that happens during a clinical trial is related to the vaccine, even though it still gets reported. Another Menactra trial reported no deaths and the serious adverse events that were reported weren’t related to getting vaccinated.

Here is another meningococcal study in which a few of the participants died – one in a car accident and the other a drug overdose.

These deaths were not related to getting vaccinated, but were listed because they occurred during the study.
These deaths were not related to getting vaccinated, but were listed because they occurred during the study.

Unfortunately, vaccines can’t protect you from everything…

It would be especially nice if they could protect us from bad anti-vaccine memes.

More on Meningococcal Vaccine Safety

Vaccine Requirements for College Entry

Most of our kids are up-to-date on their vaccines by the time they are ready to start college.

That’s likely why few of us give college vaccine requirements much thought.

Will this chicken pox outbreak in Ohio spread?
Will this chicken pox outbreak in Ohio spread?

But maybe it is something we should start thinking about more, as it seems that many colleges do not have actually require their students to be vaccinated and protected!

Vaccine Requirements for College Entry

The one vaccine that is the most often associated with going to college is the one that protects our kids against meningococcal disease.

That’s actually two vaccines though:

  • MCV4 – Menactra or Menveo
  • MenB – Bexsera or Trumenba

Which other vaccines should kids get before going to college?

They should get whatever vaccines they might have missed when they were younger, including MMR, chicken pox, hepatitis A, hepatitis B, Tdap, HPV, and polio vaccines.

Plus they should get a flu vaccine every year.

Vaccine Recommendations for College Entry

Unfortunately, in many cases, instead of requirements to attend college, we really just have recommendations that students can choose to ignore.

What’s the likelihood that your fellow students are vaccinated and protected?

How many are unvaccinated?

Which school do you plan on attending?

“Immunizations are recommended to protect your health and the health of others, but they are not required by the university.”

Welcome to the University of Michigan!

Fortunately, most schools do require at least some vaccines.

In addition to either Menactra or Menveo, many require two doses of MMR.

Some also require three doses of hepatitis B vaccine.

A few, like the University of Michigan and the University of Wisconsin don’t require any vaccines though.

These are the ten of the biggest colleges in America, at least in terms of enrollment, and their immunization rules:

TdapMMRVarHepA/BMCV4MenBHPVIPV
OSU12
2X/31XX4
FlaR2RR/31RRR
Minn12XXXXXX
ASUR2XXRXRX
UTRRRR/R1XRX
UCFR2RR/RRRRR
A&MXXXX1XXX
MichRRRR/RRXRR
PSU
R2RR/RRRRX
WiscRRRR/RRX
RR

On the bright side, Ohio State University, with one of the largest combined graduate and undergraduate enrollment, has the strongest immunization requirements.

On the other hand, it is quite sad that many of the others either have weak requirements, only recommend (R), but don’t actually require many common immunizations for enrollment, or don’t even mention them (X).

Why don’t more colleges have stricter immunization requirements for enrollment?

It is likely that they haven’t caught up with the problem of parents skipping or delaying their kids’ immunizations.

“While many infectious diseases such as meningitis are rare, it is not uncommon for hundreds of students at a large university to contract the flu each season.”

Contagious on campus

Which brings us to a problem – how can colleges hope to control outbreaks well if they don’t even know which students are vaccinated or not, and so can’t easily quarantine unvaccinated students? They seem to manage mumps and meningococcal outbreaks, but neither are as contagious as measles or chicken pox. 

Do we really need to wait for more outbreaks on college campuses before we start requiring that kids be vaccinated and protected before going to college?

At the very least, can we at least start tracking vaccine-preventable disease rates in college kids, make flu deaths in college students reportable, and report vaccination exemption rates by college campus?

More on Vaccine Requirements for College Entry