Tag: polio vaccines

Wonder Why My Parents Didn’t Give Me Vaccines?

Did your parents vaccinate and protect you against polio, measles, and whatever other diseases were vaccine preventable when you were a child?

Tom Little's editorial cartoon about an unvaccinated child with polio originally appeared in the Nashville Tennessean on January 12, 1956.
Tom Little’s editorial cartoon about an unvaccinated child with polio originally appeared in the Nashville Tennessean on January 12, 1956.

Or did they skip and delay a few, hoping you wouldn’t get sick?

Wonder Why My Parents Didn’t Give Me Salk Shots?

Tom Little helped parents understand what that might feel like without actually having to regret making a poor decision.

The inspiration for Tom Little's cartoon came from thinking of the "children who were left unprotected from from polio through no fault of their own."
The inspiration for Tom Little’s cartoon came from thinking of the “children who were left unprotected from from polio through no fault of their own.”

In addition to receiving a number of prizes and awards, including the Pulitzer Prize for Editorial Cartoons, he helped convince a lot of parents to vaccinate and protect their kids against polio.

Tom Little's cartoon helped get kids vaccinated and protected.
Tom Little’s cartoon helped get kids vaccinated and protected.

The cartoon, published 64 years ago, was so effective, it was distributed nationally by the National Foundation for Infantile Paralysis.

Would it be effective today?

In 1972, there was an outbreak of paralytic polio among unvaccinated students at Daycroft, a Christian Science boarding school in Greenwich, Connecticut.

What do kids think when they get sick after being exposed to a life-threatening disease that has been vaccine-preventable for many years?

Hopefully we won’t have much opportunity to find out…

More on Regret Not Vaccinating

What Happens if We Stop Using Oral Polio Vaccines?

As we occasionally hear reports of vaccine derived polio, it shouldn’t be surprising that anti-vaccine folks are calling for the end of all use of the oral polio vaccines that can trigger these cases.

Do you recognize the NVIC and ICAN? Think Barbara Loe Fisher and Del Bigtree... and ask them why they want to bring back polio.
Do you recognize the NVIC and ICAN? Think Barbara Loe Fisher and Del Bigtree… and ask them why they want to bring back polio.

Got any idea of what would happen if anyone listened to them?

What Happens if We Stop Using Oral Polio Vaccines?

Believe it or not, a plan is already in place to stop using oral polio vaccines.

So why haven’t we done it yet?

“In April 2016 a switch was implemented from trivalent OPV to bivalent OPV in routine immunization programmes. Following WPV1 and WPV3 eradication, use of all OPV in routine immunizations will be stopped.”

OPV Cessation

It is obviously because we haven’t yet eradicated wild polio!

“The GPEI’s achievements are evident not just in the retreat of WPV to geographic corners of the world, but also in the successive elimination of WPV types. In 2015, WPV type 2 was declared eradicated; WPV type 3 has not been seen since 2012; and while WPV1 has yet to be interrupted, its incidence has been reduced by over 90% since 2014.”

Polio Endgame Strategy 2019–2023

We are very close though.

“In impoverished communities with substandard sanitation and living conditions, vaccine strain poliovirus can contaminate water sources used for bathing and drinking, which can lead to more cases of vaccine strain polio paralysis,” said Barbara Fisher, co-founder and president of the National Vaccine Information Center. “Until polio eradication campaigns stop using live oral polio vaccine, the vaccine strain polio virus will continue to cripple children and adults.”

Vaccination-wary groups call for halt of oral polio vaccine

But if we stopped using oral polio virus vaccines before polio was eradicated, we would simply start seeing more cases of wild polio. And they would be at much higher levels than the vaccine derived cases we are seeing now.

“While over 18 million people who would have been paralysed by polio are walking today as a result of the eradication programme, we have not yet reached zero – and our mission to reach every last child remains as urgent as ever. If we stop our efforts now, within ten years we could see as many as 200,000 new cases each year, all over the world. Simply put, children everywhere remain at risk until polio is eradicated.”

Polio Endgame Strategy 2019–2023

Is that what Barbara Loe Fisher is proposing?

The Endgame Plan 2013-2018 succeeded in certifying South-East Asia (SEARO) as polio-free, brought the African Region closer than ever to eradication of wild poliovirus,  possibly eradicated two out of three wild poliovirus strains, set the world on the path of phased Oral Polio Vaccine (OPV) removal, stopped outbreaks in Syria and Horn of Africa, and cornered wild poliovirus circulation to a joint cross-border reservoir between Afghanistan and Pakistan.
The Endgame Plan 2013-2018 “succeeded in certifying South-East Asia (SEARO) as polio-free, brought the African Region closer than ever to eradication of wild poliovirus, possibly eradicated two out of three wild poliovirus strains, set the world on the path of phased Oral Polio Vaccine (OPV) removal, stopped outbreaks in Syria and Horn of Africa, and cornered wild poliovirus circulation to a joint cross-border reservoir between Afghanistan and Pakistan.”

What if instead of just stopping oral polio vaccinations, we went ahead and switched to IPV now, before wild virus interruption?

Would that be so bad?

Well yeah, it would, since IPV doesn’t stop the transmission of the polio virus.

IPV does prevent you from actually getting paralytic polio, but not from getting a polio infection and spreading it to others. So if we switched to IPV now, we would never actually eradicate polio.

OPV, on the other hand, prevents both paralytic polio and the spread of infection. Unfortunately, it can also rarely mutate and cause paralytic polio. And when vaccination rates are low, these mutant strains can even cause outbreaks.

Why do the outbreaks of mutant strains of polio only happen when vaccination rates are low? Because in addition to preventing infection from wild strains, the polio vaccines can prevent paralytic polio that is caused by the mutant strains!

But why use a vaccine that can mutate like that? It’s simple. The risk of wild polio is so much greater before OPV gets wild polio virus strains under control.

Don’t Spoil the Polio Endgame

There have been some hiccups, but we are very close to eradicating polio.

“In 1988, when the World Health Assembly declared its commitment to eradication and the Global Polio Eradication Initiative (GPEI) was formed in pursuit of this goal, there were 350 000 annual cases of WPV in 125 countries. By the end 2018, only 33 cases were identified – all from two neighbouring countries (Afghanistan and Pakistan).”

Polio Endgame Strategy 2019–2023

And while there are plenty of challenges ahead, including:

  • Ongoing conflicts in the last remaining polio-affected regions.
  • Weak or fragile health systems and extreme poverty in both endemic and non-endemic countries.

Let’s not add to those challenges and let anti-vaccine folks bring back polio.

“The medical establishment repeatedly claims that the science regarding vaccines is settled,” said Del Bigtree, CEO and founder of Informed Consent Action Network, adding that the outbreak of vaccine-derived cases “highlights the danger of eliminating the human and civil right of informed consent with regard to vaccines — a right available for all other medical products and procedures.”

Vaccination-wary groups call for halt of oral polio vaccine

Let’s not let them scare parents away from vaccinating and protecting their kids, which would lead to even more cases of both wild polio and vaccine derived polio.

More on the Polio Endgame

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