Tag: mumps outbreaks

Vaccines – Year in Review 2018

Another year has passed and although anti-vaccine folks keep talking about those 300 vaccines in pipeline, there were few new developments in the vaccine world in 2018.

Bob Sears got in trouble with the Medical Board of California over vaccine exemptions.
This happened in 2018.

Well, maybe that’s not entirely true.

Vaccines – Year in Review 2018

So what can we say about 2018 when it comes to vaccines?

Well, we did get some new ones!

  • approved by the FDA in late 2017, a new hepatitis B vaccine for adults, Heplisav-B, the formal recommendation for its use from the ACIP came on February 21, 2018
  • although it was both approved by the FDA and formally recommended by the ACIP in late 2017, Shingrix, the new shingles vaccine, became more widely available in 2018 – well kind of – there have been a lot of shortages due to high demand for the vaccine
  • Vaxelis, a hexavalent vaccine that combines DTaP-IPV-Hib-HepB into one shot was FDA approved on December 21, 2018, but likely won’t be available for a few more years
  • FluMist, the nasal spray flu vaccine, returned

And we lost one… Last year was the first full year that Menomune, an older meningococcal vaccine, was no longer available. It was discontinued because of low demand, as we began to use the newer vaccines, Menactra and Menveo instead.

In other immunization news:

  • a 2017 shortage of yellow fever vaccine continued into 2018
  • a shortage of monovalent pediatric hepatitis B vaccine will continue into 2019 (doesn’t affect combination vaccines with hepatitis B)
  • Gardasil 9 received an expanded recommendation – women and men between the ages of 27 and 45 years can now get vaccinated and protected with this HPV vaccine
  • the hepatitis A vaccine got a lower age recommendation – at least in special situations – “HepA vaccine be administered to infants aged 6–11 months traveling outside the United States when protection against HAV is recommended.”
  • the recommendation to use a third dose of MMR to control outbreaks of mumps was formally approved
  • the WHO updated its recommendations for use of the dengue fever vaccine (Dengvaxia) to makes sure that only dengue-seropositive persons are vaccinated, as they found an increased risk of severe dengue in seronegative people who were vaccinated
  • Of the 163 million to 168 million doses of flu vaccine that will be distributed in the United States for the 2018-2019 season, more than 80% will be thimerosal free.
  • China had an issue with substandard DTaP vaccines made by one company in one part of the country
  • India had an issue with contaminated polio vaccines made by one company in one part of the country – bivalent oral polio vaccines (two strains) still contained all three strains of polio vaccine virus
  • Measles cases and deaths spiked globally because of gaps in vaccination coverage

If you didn’t hear about any of those things in the news, you may have heard about the death of two young children in Samoa after they received an MMR vaccine. That tragedy almost certainly was caused by an error in administering/mixing the vaccines, and not because there was anything wrong with the vaccines themselves.

Need help getting educated about vaccines? Despite continued outbreaks, 2018 was a good year for vaccine advocates and vaccine education.

Several good books about vaccines were published, including:

And in case you missed it, we found out that:

Of course, for most of us, none of this is really news. We know that vaccines are safe, effective, and necessary.

And sadly, Betty Bumpers died. We can honor her legacy by continuing her work and helping to make sure that every child gets vaccinated and protected.

More on Vaccines Year in Review 2018

Does Japan have the Lowest Infant Mortality Rate Following a Ban on Mandatory Vaccinations?

Vaccines don’t affect infant mortality rates as much as you would expect, because there are many other things that kill infants besides vaccine-preventable diseases. Things like birth defects, prematurity, injuries and complications during pregnancy.

Unfortunately, that gives anti-vaccine folks lots of opportunities to misuse statistics about infant mortality rates.

Does Japan have the Lowest Infant Mortality Rate Following a Ban on Mandatory Vaccinations?

The latest propaganda about vaccines and infant mortality rates relates to Japan.

“It may come as no surprise to many that the Japanese Government banned a number of vaccines that are currently mandatory in the United States and has strict regulations in place for other Big Pharma drugs and vaccines in general.”

Jay Greenberg on Anti-Vaccine Japan Has World’s Lowest Child Death Rate, Highest Life Expectancy

Most folks will understand why this is simply propaganda.

Japan never banned any vaccines.

The 2016 routine and voluntary immunization schedule in Japan.
The 2016 routine (Hib, Prevnar, hepB, DTaP, IPV, BCG, MR, Varicella, Japanese Encephalitis, DT, and HPV) and voluntary (mumps, rotavirus, hepA, meningococcal) immunization schedule in Japan.

Japan is not anti-vaccine. Although their immunization schedule is certainly a lot more complicated than ours, they give many of the same vaccines as every other developed country.

“Following a record number of children developing adverse reactions, including meningitis, loss of limbs, and even sudden death, the Japanese government banned the measles, mumps, and rubella (MMR) vaccine from its vaccination program, despite facing serious opposition from Big Pharma.”

Was the MMR vaccine banned in Japan?

The MMR vaccine was introduced in Japan in 1989, and four years later, the government withdrew its recommendation for the vaccine.

Why? Reports of aseptic meningitis. This was likely due to the Urabe strain of the mumps component in their MMR vaccine, which was not used in the United States.

“The data up to now have revealed low rates of aseptic meningitis and no cases of virologically proven meningitis following the use of Jeryl–Lynn and RIT 4385 strains.”

WHO on Safety of mumps vaccine strains

They didn’t ban the vaccine or vaccination though.

They returned to giving children separate measles, rubella, and mumps (optional) vaccines. Tragically, because many kids didn’t get vaccinated against mumps, the rate of aseptic meningitis from people who actually got mumps was 25 times higher than the rate from the MMR vaccine!

When comparing risks vs benefits, it clearly favored getting vaccinated.

“Due directly to these gaps in ‘herd’ immunization resulting from politicized transitions in vaccination policy by the government, there were outbreaks of rubella with 17,050 cases reported between the years of 2012 and 2014, and 45 cases of congenital rubella syndrome reported to the National Epidemiological Surveillance of Infectious Diseases from week 1, 2012 to week 40, 2014.”

Yusuke Tanaka on History repeats itself in Japan: Failure to learn from rubella epidemic leads to failure to provide the HPV vaccine

The switch over also lead to outbreaks of rubella and increased cases of congenital rubella syndrome.

That’s no surprise to those who remember what happened in 1975, when routine pertussis vaccinations were halted in Japan following the deaths of two children. That eventually lead to epidemic cases of whooping cough in the country and at least 41 deaths in children (in 1979) before the vaccine was restarted.

Unfortunately, once they moved to DTaP vaccines, they started to see an increase in allergic reactions after kids got their MMR vaccine. Why? Their version of the DTaP vaccine contained poorly hydrolyzed bovine gelatin, which likely sensitized infants, who then developed an allergic reaction after getting an MMR vaccine with gelatin. While gelatin was removed from their DTaP vaccines, these extra side effects likely scared some folks in Japan.

Japan’s Vaccine Problem

Japan has more vaccine-preventable diseases than many other industrial countries.

Is it because Japan is anti-vaccine?

Of course not.

By impulsively halting and withdrawing vaccines, the Japanese government has done a good job of scaring folks though. They have also been very slow to introduce new vaccines, although they are catching up, as hepatitis, B, rotavirus, Hib, pneumococcal, meningococcal, HPV, and the chicken pox vaccine are all now available in Japan.

Have there been any benefits?

Nope.

They might have lower infant mortality rates, but that has nothing to do with vaccines.

There is no correlation between the number of vaccines that a country gives and their infant mortality rate.

If infant mortality rates are linked to vaccines, how do you explain Finland?
If infant mortality rates are linked to vaccines, how do you explain Finland?

Just look at the immunization schedules in Finland, Portugal, and other countries.

What about autism?

Rates of autism have increased in Japan, just as they have in other countries. So much for the idea that the MMR vaccine is associated with autism, right?

It should be obvious now that if anti-vaccine folks did any research at all, they wouldn’t use Japan as an example when they talk about vaccines.

With higher rates of vaccine-preventable disease and deaths from vaccine-preventable diseases, especially right after they impulsively halt a vaccine, Japan’s vaccine history simply demonstrates that vaccines work and that they are still very necessary.

One thing is true though. Japan’s infant mortality rate has been dropping, but then so has the infant mortality rate in almost all other countries, including the United States, which is at record low levels.

It certainly isn’t true that Japan’s infant mortality rate started to drop following a ban on mandatory vaccinations. How do we know that? Like many other countries, Japan has never had mandatory vaccinations. And not surprisingly, their infant mortality rate has continued to drop as they have added more vaccines and improved their immunization rates.

More on Vaccines and Infant Mortality Rates

How Do They Figure out Who Starts an Outbreak?

As we continue to see outbreaks of vaccine-preventable diseases in the post-vaccination era, it is important that these outbreaks be quickly contained.

But it is important to understand that these outbreaks don’t simply stop on there own. A lot of work goes into containing them.

Working to Contain an Outbreak

And that work containing outbreaks is expensive. Much more expensive than simply getting vaccinated.

For example, the total personnel time and total direct cost to the New York City Department of Health and Mental Hygiene responding to and controlling the 2013 outbreak in NYC were calculated to be at least $394,448 and 10,054 personnel hours.

Why it is so expensive is easy to see once you understand all of the work that goes into containing an outbreak. Work that is done by your local health department as soon as a case of measles, or other vaccine-preventable disease, is suspected.

Work that, for a measles outbreak for example, includes:

  • initiating a case and contact investigation
  • quickly confirming that the patient actually has measles, including testing
  • assessing the potential for further spread – identifying contacts who aren’t immune to measles and are at risk for getting measles
  • isolating people with measles and quarantining contacts who aren’t immune to measles for at least 21 days after the start of the measles rash in the last case of measles in the area, including everyone who is intentionally unvaccinated
  • offering postexposure vaccination, a dose of the MMR vaccine within 72 hours of exposure to contacts who are not fully immune so that they can get some protection maybe don’t have to be quarantined
  • having targeted immunization clinics in the affected population, such as a school or church, to get as many people vaccinated as possible, even after 72 hours, so they have can be protected in the future

That’s an awful lot of work.

Work that continues until the outbreak officially ends.

Finding the Source of an Outbreak

Another big part of the work that goes on to contain an outbreak is identifying the source of the outbreak.

Was it someone who had recently been traveling overseas, a visitor from out of the country, or someone that was already part of an another outbreak?

Why is that so important?

If you don’t find the source of the outbreak, then you can’t be sure that you have found all of the people that have been exposed, and the outbreak might go on for an extended period of time.

And no, it is never shedding, a vaccine strain, or a recently vaccinated child that causes these measles outbreaks.

Anatomy of a Measles Outbreak

A closer look at the measles outbreak in San Diego, California in 2008 can help folks understand even better what happens during one of these outbreaks.

A 7-year-old who is unvaccinated because his parents have a personal belief vaccine exemption travels to Switzerland with his family.

A week after returning home from the trip, he gets sick, but returns to school after a few days. He then develops a rash and sees his family physician, followed by his pediatrician, and then makes a trip to the emergency room because he continues to have a high fever and rash (classic measles symptoms).

He is eventually diagnosed with measles, but not before eleven other children are infected with measles. This includes two of his siblings, five children in his school, and four children who were exposed at his pediatrician’s office.

It is not as simple as that though.

During this measles outbreak:

  • Three of the children who became infected were younger than 12 months of age, and were therefore too young to have been vaccinated
  • Eight of the nine children who were at least 12 months old were intentionally unvaccinated because they also had personal belief vaccine exemptions
  • About 70 children were placed under voluntary quarantine for 21 days after their last exposure because they were exposed to one of the measles cases and either didn’t want to be vaccinated or were too young
  • One of the infants with measles traveled to Hawaii, raising fears that the measles outbreak could spread there too

All together, 839 people were exposed to the measles virus.

This family didn't have a choice about their son getting sick - he was too young to be vaccinated when he was exposed to an unvaccinated child with measles.
This family didn’t have a choice about their son getting sick – he was too young to be vaccinated when he was exposed to an unvaccinated child with measles.

At least one of them was a 10-month-old infant who got infected at his well child checkup, was too young to have gotten the MMR vaccine yet, and ended up spending three days in the hospital – time his parents spent “fearing we might lose our baby boy.”

The parents of this 10-month-old weren’t looking for a vaccine exemption and didn’t want their child to catch measles, a life-threatening, vaccine-preventable disease. Instead, they were counting on herd immunity to protect him until their child could be protected with an MMR vaccine. They were one of “those who come into contact with them” that got caught up in a decision of some other parents to not vaccinate their child.

The kids who are at risk and get a vaccine-preventable disease because they are too young to get vaccinated, have an immune system problem that prevents them from getting immunized or their vaccine from working, and the kids who simply didn’t get protected from a vaccine are the hidden costs of these measles outbreaks that we don’t hear about often enough.

What to Know About Finding the Source of an Outbreak

Without all of the hard work that goes into containing outbreaks, the outbreaks of measles, pertussis, mumps, hepatitis A, and other vaccine preventable diseases would be even bigger.

More on Finding the Source of an Outbreak

 

Which Vaccines Don’t Prevent the Spread of a Disease?

As most folks know, Dr. Bob Sears has been put on probation by the California Medical Board.

Most vaccines don't prevent the spread of diseases?
Most vaccines don’t prevent the spread of disease???

Surprisingly, that hasn’t kept him from posting dangerous misinformation about vaccines, including his latest idea that “most vaccines don’t prevent the spread of a disease.”

Which Vaccines Don’t Prevent the Spread of a Disease?

If vaccines don’t prevent the spread of disease, then how did we eradicate, eliminate, and control so many diseases?

Dr. Bob Sears actually reassured parents that measles wasn't deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe - another well-nourished population with lower vaccination rates than the U.S.
At least seven people have died in Italy with measles over the last few years. That’s not so good for Italy.

When was the last time you saw someone with small pox, rubella, diphtheria, or polio, for example?

It is true that vaccines don’t prevent the spread of some infections though.

There is tetanus, for example, but guess what?

Tetanus isn’t contagious.

Any others?

Well, unlike most other vaccines, the meningococcal B vaccines are not thought to decrease nasal carriage of the meningococcal B bacteria. So if you are vaccinated and an asymptomatic carrier of the bacteria, you could theoretically spread it to someone else, as could someone who is unvaccinated.

Still, the MenB vaccines can protect you from getting actual meningococcal B disease, and if you don’t have meningococcemia or meningococcal meningitis, you won’t expose and spread it to someone else. That’s why the MenB vaccines are especially useful in outbreak situations.

Any others? After all, Dr. Bob did say that “most vaccines don’t prevent the spread of a disease.”

Vaccines That Don’t Prevent the Spread of a Disease

There are a few other examples of vaccines that don’t prevent the spread of a disease.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

Of course, any vaccine that is delayed or skipped won’t work to prevent the spread of a disease.

Just like they are seeing measles outbreaks and deaths now, because of low vaccination rates, in Ukraine there were 17,387 cases of diphtheria and 646 deaths from 1992 to 1997. Also high, were cases of measles (over 23,000 cases in 1993) and pertussis (almost 7,000 cases in 1993).

And because of waning immunity, vaccines don’t do as good a job of preventing the spread of pertussis and mumps as we would like. Still, that’s only when the vaccines don’t work, and even then, as Dr. Bob says, they do work to reduce the severity of symptoms.  During recent mumps outbreaks, the rates of complications are far below historical levels. The same is true for pertussis.

Have you ever seen or heard an unvaccinated child with pertussis? It is truly heartbreaking, especially when you realize how easily it could be prevented.

We typically see the same thing with flu. Even when the flu vaccine isn’t a good match or isn’t as effective as we would like, it still has a lot of benefits, including reducing your risk of dying.

“IPV induces very low levels of immunity in the intestine. As a result, when a person immunized with IPV is infected with wild poliovirus, the virus can still multiply inside the intestines and be shed in the faeces, risking continued circulation.”

Inactivated poliovirus vaccine

Does the fact that IPV, the inactivated polio vaccine, can sometimes lead to infections and shedding mean that it doesn’t prevent infections?

Of course not!

“IPV triggers an excellent protective immune response in most people.”

Inactivated poliovirus vaccine

Most people vaccinated with IPV will be immune, won’t get wild polio, and so won’t be able to get anyone else sick.

Vaccines reduce disease by direct protection of vaccinees and by indirect protection of nonimmune persons. Indirect protection depends on a reduction in infection transmission, and hence on protection (immunity) against infection, not just against disease. If a vaccine were to protect only against disease, and not at all against infection, then it would have no influence on infection transmission in the community and there would be no indirect protection (vaccination of one person would have no influence on any others in the community). It would be possible to reduce disease with such a vaccine but not to eradicate the infection.

Plotkin’s Vaccines

But because IPV doesn’t provide indirect protection, we still use OPV in parts of the world where polio is more of a problem.

Vaccines work. Even the few that don’t prevent the spread of infections, still help to reduce disease.

What’s the Difference Between Infections and Disease?

Wait, is there a difference between infection and disease?

Yes there is, something that Dr. Bob, who actually wrote a book about vaccines, seems to have overlooked.

An infection is simply the presence of a virus, bacteria, or other organism in your body.

A disease, on the other hand, is a virus or bacteria in your body causing signs and symptoms.

All vaccines work to prevent disease, or at least they do when you actually get vaccinated.

A very few don’t prevent infections and the spread of infections, but that is not a good reason to skip or delay your child’s vaccines. In fact, it is one of the reasons why it is important to have high vaccination rates! Even natural infections don’t always keep you from becoming asymptomatic carriers that can infected others. Many people who have natural typhoid (remember Typhoid Mary?) and hepatitis B infections go on to become chronic carriers without any symptoms, but still able to infect others.

If you understand that a few vaccines don’t prevent the spread of infections, then you should understand that you can’t hide in the herd and expect to be protected, even though most folks around you are vaccinated.

What to Know About Vaccines and the Spread of Disease

Despite what Dr. Bob says, almost all vaccines work to prevent the spread of disease and infections, at least they do when you get your kids vaccinated.

More on Vaccines and the Spread of Disease