Tag: polio vaccines

Why Do Anti-Vax Folks Get Excited About Polio Outbreaks?

At least two things happen whenever we hear about a new polio outbreak. And yes, I said polio outbreak.

One is that many people assume it is wild polio and that we are moving further away from finally eradicating polio.

Hopefully folks understand that polio outbreaks wouldn't just stop if we stopped vaccinating...
Hopefully folks understand that polio outbreaks wouldn’t just stop if we stopped vaccinating…

And the other?

Anti-vax folks assume that it is an outbreak of vaccine strain polio and very wrongly use this as a reason to try and scare parents away from vaccinating and protecting their kids.

“The polio outbreak in the Philippines is confirmed to be from a circulating vaccine-derived poliovirus type 2. This is of particular concern, as wild poliovirus type 2 was certified as globally eradicated in 2015. Poorly conducted immunization activities, when too few children have received the required three doses of polio vaccine, leave them susceptible to poliovirus, either from vaccine-derived or wild polioviruses. Full immunization protects them from both forms of the virus.”

WHO, UNICEF and partners support Philippine Department of Health’s polio outbreak response

As expected, that’s the response we are seeing from anti-vax folks to news of the latest outbreak of polio in the Philippines.

Why Do Anti-Vax Folks Get Excited About Polio Outbreaks?

But isn’t bad that the polio vaccine can actually cause outbreaks?

Of course!

No one wants people to get sick after getting vaccinated. And that’s why we are moving towards stopping the use of the oral polio vaccine that causes vaccine derived polio.

It is also very important to consider the alternative. A lot more people getting wild polio!

“As recently as 30 years ago, wild poliovirus paralysed more than 350,000 children in more than 125 countries every year. In 2018 there were fewer than 30 reported cases in just two countries – Afghanistan and Pakistan.”

“Zero polio transmission and health for all”, WHO Director-General gives new year’s wish to the people of Afghanistan and Pakistan

We also need to remember the reason we typically see outbreaks of vaccine strain polio. It is because vaccination rates have dropped in an area!

Wait, what?

Yes, that’s right. The polio vaccine, in addition to protecting you from wild polio can prevent you from getting the vaccine strain polio too.

But isn’t the polio vaccine causing many more cases of polio than the actual polio virus?

Bob Sears recently shared an article that was two years old about mutant strains of polio causing outbreaks

It once was, but that’s simply because we are getting very close to eradicating polio and there were fewer cases of wild polio!

While there were far more cases of vaccine derived polio than wild polio last year, there were more cases of wild polio earlier in 2019 and it is now about even.

Tragically, we are starting to see more and more cases of wild polio.

Science event in Washington, D.C. reminding folks that Vaccines Work.
Pediatricians at the March for Science event in Washington, D.C. reminding folks that Vaccines Work.

Still, we are no where near the numbers of cases of polio and kids getting paralyzed when polio was epidemic in most countries.

And the outbreaks of vaccine derived polio?

They demonstrate what happens when we don’t keep up our immunization rates. And how anti-vax folks either don’t understand or intentionally try to misinform parents about how vaccines work.

More on Polio Outbreaks

Vaccine Schedules from the 1940s to 2019

To scare parents away from vaccinating and protecting their kids, anti-vaccine folks continue to push the idea the kids get too many vaccines at too early an age.

They don’t.

When did we have a vaccine schedule when we gave just two vaccines?
When did we have a vaccine schedule when we gave just two vaccines?

They try to reinforce the idea by comparing things to the “good ol’ days,” when they think kids only got one dose of one or two vaccines.

Did they?

Vaccine Schedules from the 1940s to 2019

Let’s take a look at how the vaccine schedule has evolved over time to see how many vaccines kids used to get. Looking at the old vaccine schedules can also help you understand how we got to our current schedule.

Although not a formal schedule, the first vaccine recommendations were published in the AAP’s Special Committee on Prophylactic Procedures Against Communicable Diseases 1938 pamphlet, Routine measures for the prophylaxis of communicable diseases.

It included vaccines against diphtheria, pertussis, rabies, tetanus, tuberculosis, typhoid fever, and smallpox.

A schedule of immunizations from a 1948 AAP Round Table Discussion on the Practical and Immunological Aspects of Pediatric Immunizations
A schedule of immunizations from a 1948 AAP Round Table Discussion on the Practical and Immunological Aspects of Pediatric Immunizations

That’s the schedule from 1948!

Surprised?

Many of you were led to believe that kids only got 2 vaccines back in the day. Instead, they got more vaccines and multiple doses of those vaccines.

Multiple doses with formaldehyde inactivated vaccines which contained aluminum. And thimerosal. And far more antigens than kids are exposed to today, even though they now get many more vaccines.

My uncle got polio around the time this vaccine schedule was released in 1951, but before the first polio vaccines were being routinely used.
My uncle got polio around the time this vaccine schedule was released in 1951, but before the first polio vaccines were being routinely used.

By the early 1950s, the DPT vaccine became routine. Other vaccines were also available for special situations, including rabies, typhoid, parathyphoid, and the BCG vaccine.

And of course, we got the polio shot in 1955!

Kids got multiple doses of DPT, DT, polio, and smallpox vaccines in 1960.
Kids got multiple doses of DPT, DT, polio, and smallpox vaccines in 1960.

Although few people remember, the original polio vaccines were monovalent and only included one polio strain in each shot. So you had to get multiple shots to get protected from all three strains!

The polio shot, was used until 1962, when we switched to the oral polio vaccine. Trivalent OPV wasn’t licensed until 1963 though. Before that, kids got multiple doses of monovalent OPV, types 1, 2, and 3.

The ACIP committee came up with four different dosage schedules for measles vaccines in 1964.
The ACIP committee came up with four different dosage schedules for measles vaccines in 1964.

And for a few years, we had both inactivated and live measles vaccines…

The recommended immunization schedule by the AAP in the 1966 Red Book. The first measles vaccine was approved in 1963.

Next came the individual mumps (1967) and rubella (1969) vaccines and the combination MMR vaccine (1971).

And the end of routine vaccination with the smallpox vaccine (1972).

Eleven doses of four vaccines protected kids against seven vaccine-preventable diseases in 1983.
Eleven doses of four vaccines protected kids against seven vaccine-preventable diseases in 1983.

The Hib vaccine was added in 1985.

Twelve doses of five vaccines protected kids against eight vaccine-preventable diseases in 1989.
Twelve doses of five vaccines protected kids against eight vaccine-preventable diseases in 1989.

Next came the hepatitis B vaccine and expanded age ranges for the Hib vaccine.

Seventeen doses of five vaccines protected kids against eight vaccine-preventable diseases in 1989 (plus the later Td booster).
Nineteen doses of six vaccines protected kids against nine vaccine-preventable diseases in 1995.

What’s still missing?

Vaccines and protection against rotavirus, hepatitis A, chicken pox, flu, pneumococcal bacteria, meningococcal bacteria, and HPV. And no, they weren’t all added right after the National Childhood Vaccine Injury Act of 1986, another anti-vaccine myth!

Those vaccines were added to the schedule much later:

  • Varivax – a chickenpox vaccine (1995)
  • the polio shot – we began to switch back in 1996
  • VAQTA – the first hepatitis A vaccine was approved for high risk kids in 1996, but wasn’t actually added to the routine vaccine schedule until 2006
This is the immunization we used when I finished residency...
This is the immunization we used when I finished residency…

RotaShield, the first rotavirus vaccine was approved in 1998 but was quickly withdrawn in 1999 because of an increased risk of intussusception

What’s next?

  • Prevnar, with protection against pneumococcal bacteria (2000)
  • FluMist – the nasal spray flu vaccine (2004)
  • new flu shots recommendations for all healthy infants (2004)

Is the vaccine schedule starting to look familiar?

RotaTeq and Gardasil were added to the vaccine schedule the next year, in 2007.
RotaTeq and Gardasil were added to the vaccine schedule the next year, in 2007.

Since then, Prevnar was updated to include protection against 13 strains of pneumococcal bacteria. And we got a new vaccine that covers the B strain of meningococcal disease, but otherwise there haven’t been any major changes to the vaccine schedule in a while.

The 2019 vaccine schedule.
The 2019 vaccine schedule.

Do you see 72 vaccines on the schedule?

Kids today routinely get 13 vaccines that protect them 16 vaccine-preventable diseases.

Do you see 72 doses of vaccines on the schedule?

Guess what? These folks are deliberately misleading you.
Guess what? These folks are deliberately misleading you.

Kids don’t get 72 doses of vaccines today.

That’s an inflated number that’s used to scare parents. That it is a propaganda technique should be obvious, as the folks who use it don’t use the same anti-vaccine math to inflate the number of doses from the historical schedules.

More on Vaccine Schedules from the 1940s to 2019

Do You Remember Sabin Sundays?

You may have heard of the Polio Pioneers, the kids who got Jonas Salk‘s original inactivated polio vaccine in 1954.

They were part of a large clinical trial, getting either the polio shot or a saline placebo, and helped prove that the vaccine was safe and effective.

Do You Remember Sabin Sundays?

Of course, that wasn’t the end of the story though.

After the Cutter Incident, Albert Sabin soon proved that his live, oral polio vaccine was better than Salk’s inactivated polio vaccine.

And it was first given in the United States on April 24, 1960 – the first Sabin Sunday, when 20,000 children came to Cincinnati Children’s to receive his sugar cube vaccine.

“On three consecutive Sundays — “Sabin Sundays” — in 1960, millions of families lined up at churches and schools across the country to swallow a spoonful of pink syrup or a sugar cube treated with a life-saving polio vaccine, developed by UC researcher Albert Sabin.”

Sabin Sunday, 1960

Sabin Oral Sunday immunization programs continued over the next few years all over the country as kids got caught up on their polio vaccines.

Several Sabin Sundays were held in Arizona in 1962.

Can you imagine taking your kids to school to get them vaccinated on a Sunday?

Millions of parents did it!

Newspapers urged folks to attend the Sabin on Sunday clinics to help end the threat of "crippling poliomyelitis."
Newspapers urged folks to attend the Sabin on Sunday clinics to help end the threat of “crippling poliomyelitis.”

They lined up to get their kids vaccinated and protected.

More on Sabin Sundays

What Is the Morbidity/Mortality Rate of the Polio Vaccine vs the Wild Virus?

Some anti-vaccine folks still think that the risks of vaccines are far greater than the risks of the vaccine-preventable diseases they keep you from getting.

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 those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

They aren’t, but you can kind of understand why they might think that with a disease like polio, when they might never actually have known anyone to have the disease.

What Is the Morbidity/Mortality Rate of the Polio Vaccine vs the Wild Virus?

Still, even though polio is under good control and close to being eradicated, the risk/benefit ratio clearly favors getting vaccinated and protected.

That’s because the polio vaccines are very safe and if we stopped vaccinating, polio could come back.

In fact, morbidity/mortality from polio vaccines are decreasing, as we are using much less oral polio vaccine (OPV) in the transition (OPV cessation) to just using inactivated polio vaccine (IPV).

“Over the past ten years, more than 10 billion doses of OPV have been given to nearly three billion children worldwide. More than 16 million cases of polio have been prevented, and the disease has been reduced by more than 99%. It is the appropriate vaccine through which to achieve global polio eradication.”

OPV Cessation

And while most developed countries already use IPV, those that are still using OPV recently switched from a trivalent (tOPV) to a bivalent (bOPV) form of OPV. We could do this because type 2 poliovirus has already been eradicated (2015)!

Of course, the issue with the OPV vaccines is that they rarely cause vaccine-associated paralytic polio (VAPP) and circulating vaccine-derived polioviruses (cVDPV).

Fortunately, this is even less common with bOPV.

As this chart from the WHO shows, polio vaccines are very safe.
As this chart from the WHO shows, polio vaccines are very safe.

So morbidity (getting sick)/mortality (dying) from polio vaccines is low.

There were only 31 cases of wild polio in 2018, in Afghanistan and Pakistan, and an additional 102 cases of cVDPV in 7 countries.

What about morbidity/mortality from polio?

“As recently as 30 years ago, wild poliovirus paralysed more than 350 000 children in more than 125 countries every year. In 2018 there were fewer than 30 reported cases in just two countries – Afghanistan and Pakistan.”

“Zero polio transmission and health for all”, WHO Director-General gives new year’s wish to the people of Afghanistan and Pakistan

With a 99.9% drop in polio cases since 1998, your risk of getting polio in most parts of the world is very low, but you still have to consider both the morbidity/mortality of polio in the pre-vaccine era and the risk of polio returning if we stop vaccinating before it is eradicated.

What about the idea that you don’t have to worry about polio because only 1% of kids with polio developed paralysis?

“The mortality rate for acute paralytic polio ranges from 5–15%.”

Disease factsheet about poliomyelitis

Well, when everyone gets polio, even 1% is a lot.

With such a safe vaccine, why put your kids at risk of getting polio?

Do you even understand what the risks are?

No, it isn’t just the risk of wild polio in Afghanistan and Pakistan.

Since the oral polio vaccines shed, if you are unvaccinated, in addition to the risk of wild polio, there is a small risk of getting circulating vaccine-derived polioviruses (cVDPV) if you are not vaccinated and protected. No, it is not a big risk, as there were only 102 cases of cVDPV in 7 countries in 2018, but it isn’t zero either.

And the other big risk is that if enough folks stop getting vaccinated, taking their chances hiding in the herd, polio will come back and our chance to eradicate another vaccine-preventable disease will fail.

More on the Morbidity and Mortality Rates of Polio