Tag: vaccine effectiveness

Flu Season Hype or Hazard

Is this going to be the worst flu season in history?

That certainly seems to be how the media is playing it.

Have you read any of these articles?

  • California’s deadly flu season could be worst in a decade
  • Defending against this season’s deadly flu: 5 things to know
  • The CDC says this year’s flu may reach ‘epidemic’ proportions
  • Worst of deadly flu season may still be to come, Dallas County officials say
  • Texas Is Suffering Through its Worst Flu Outbreak in Decades
  • Hospital Overrun By Flu Cases Having To Turn Them Away
  • Get ready, some medical experts are predicting the worst flu season in history

Worst flu season in history? Really?

Flu Season Hazard

Flu season can be deadly.

That’s not hype.

That’s why every one should get a flu shot each year.

Early flu seasons can be bad.

Why? They overlap with RSV season. That means that everyone is sick at the same time with bronchiolitis, croup, colds, and the flu.

They are especially bad because many people haven’t taken the time to get their flu shot yet.

And an H3N2-predominant flu season can be especially bad. In addition to high levels of pediatric flu deaths, the CDC reports that the four flu seasons that were H3N2-predominant in recent years were “the four seasons with the highest flu-associated mortality levels in the past decade.” H3N2 virus strains drift easily, so that flu vaccines are less effective.

Flu Season Hype

Right off the bat, one big problem with most of these headlines, and the way that this year’s flu season is being hyped, is folks going out of their way to use the word “deadly” every chance they can.

Every flu season is deadly!

And guess what?

Flu season reaches “epidemic proportions” each and every year!

“The United States experiences epidemics of seasonal flu each year. This time of year is called flu season.”

CDC on Frequently Asked Flu Questions 2017-2018 Influenza Season

And we get to the point, in many cities, where a hospital fills up for a few days and has to turn away flu cases. It happens with RSV too. Its called a “code Yellow” in some hospitals.

The biggest problem with the current news coverage though, is that there is no evidence that this is going to be the worst or even among the deadliest flu seasons that we have seen.

“The Centers for Disease Control and Prevention says flu season runs from about September to May. Most years in Texas, a number called the ILI percentage — the number of patients doctors see with flu-like symptoms — checks in at about 2 percent or 3 percent during the offseason and crests to about 6 percent during the worst of the flu season. This year, according to a model developed by a Carnegie Mellon University team led by Roni Rosenfeld, Texas’ ILI percentage has already risen above 13 percent.”

“This is really record-breaking. In the last 20 years [the estimated number of people presenting flu symptoms] hasn’t reached that height,” Rosenfeld says. “It’s the highest it’s been this early in the season, and it’s the highest it’s been period.”

Dallas Observer on Texas Is Suffering Through its Worst Flu Outbreak in Decades

Do you know what is wrong with that report in the Dallas Observer?

texas-flu-season-ili

It misses that the ILI percentage was above 14% in Texas during the 2014-15 flu season too! So no records are being broken, especially since the number already seems to have peaked…

texas-flu-ili-more-years

The ILI percentage was actually between 10 to just over 14% for three out of four years recently.

Will hyping the flu to make it sound even more dangerous scare folks into getting a flu shot?

Probably not, as the media is also doing a good job of scaring folks into thinking that the flu shot isn’t effective this year!

Routine CDC Telebriefings during flu season used to be a good way of keeping this kind of hype down. We don’t seem to have them anymore…

(We did finally have one the week after I first posted this article though…)

Flu Season Hype or Hazard

What does any of this mean for this year’s flu season?

The New York Times has a good story, with a good headline to match:

An important take away from the story? It actually reports on a lower hospitalization rate this year than the 2014-15 flu season, a hopeful sign that this year’s flu season won’t be worst than many others.

So far, this year's flu season is closely following the 2014-15 flu season.
So far, this year’s flu season is closely following the 2014-15 flu season.

Why is the 2014-15 flu season important?

For one thing, looking at real data and not just trying to scare folks, we can say that this year’s flu season looks a lot like the 2014-15 flu season. That was also an H3N2-predominant flu season that got off to an early start, but tragically, ended up killing at least 148 children.

The 2014-15 flu season looked a lot like the 2012-13 flu season.
The 2014-15 flu season looked a lot like the 2012-13 flu season.

I’m sure that few people remember, but the 2014-15 flu season looked a lot like another  H3N2-predominant flu season – the 2012-13 flu season. That year, we also got off to an early start and again, tragically, we ended up with 171 pediatric flu deaths.

So, is this going to be a bad flu season?

Is there ever a good flu season?

It’s hard to predict, but the odds are strongly against this being the worst flu season in history or even the worst flu season this decade.

“Indicators used to track influenza-like-activity (ILI) are similar to what was seen during the peak of the 2014-2015 season, a season of high severity. The overall hospitalization rate is high also, but still lower than the overall hospitalization rate reported during the same week of the 2014-2015 season.”

CDC Influenza Situation Update

For one thing, although it might be higher in some states, the overall hospitalization rate is lower this year.

And about the same or fewer pediatric deaths have been reported so far (30 pediatric deaths) than at the same point in either the 2012-13 (29 pediatric deaths) or 2014-15 (56 pediatric deaths) flu seasons.

“The majority of the influenza viruses collected from the United States during October 1, 2017 through January 13, 2018 were characterized antigenically and genetically as being similar to the cell-grown reference viruses representing the 2017–18 Northern Hemisphere influenza vaccine viruses.”

CDC Situation Update: Summary of Weekly FluView Report

And we don’t have a mismatched flu strain or a strain that has drifted to be concerned about.

That doesn’t mean that the flu vaccine is going to work perfectly, by any means, but it should be at least 30 to 40% effective against the circulating influenza A(H3N2) viruses. Vaccine coverage against influenza A(H1N1) and B strains should be even better.

The best news, besides a very good supply of flu vaccines and anti-viral medicines, like Tamiflu, this year?

We saw the same H3N2 strain in the United States last year. Although that might not guarantee immunity if you had the flu last year, it should offer some protection against severe disease.

Also, we have some new flu vaccines, including the cell-based vaccine, Flucelvax, and high dose flu shots and flu shots with adjuvants for adults 65 years of age and older.

Still, like most H3N2-predominant flu seasons, it will at best be a moderately severe flu season.

Worst ever? That’s doubtful.

Ignore the hype, but don’t ignore the advice to get vaccinated and protected against the flu. It’s never too late to get a flu shot. Even with an early start, flu season will continue into the spring.

What to Know About Flu Season Hype or Hazard

Like other H3N2-predominant flu seasons, this year’s flu season will be moderately-severe, but warnings that it could be the worst flu season ever are likely just hype.

More on Flu Season Hype or Hazard

Updated January 20, 2018

Do More Vaccinated or Unvaccinated Kids Get Sick in Outbreaks?

Some anti-vaccine folks continue to claim that vaccines don’t work and that most outbreaks of vaccine-preventable diseases are actually caused by kids who have been vaccinated.

They also push the myth that more vaccinated than unvaccinated kids get sick in most outbreaks.

Vaccinated vs Unvaccinated in an Outbreak

So are outbreaks usually caused by kids who have been vaccinated?

No, of course not.

Do we sometimes see more vaccinated than unvaccinated kids in some of these outbreaks?

Yes, sometimes we do.

Vaccine Epidemiology

Wait, what?

Yes, we sometimes see more vaccinated than unvaccinated kids in an outbreak.

How can that be if vaccines work?

It is actually very easy to understand once you learn a little math and a little more epidemiology.

Basically, it is because while vaccines work, they don’t work 100% of the time, and more importantly, there are way more vaccinated kids around than unvaccinated kids.

The Mathematics of Disease Outbreaks

That means that you need to understand that more than the absolute number of vaccinated and unvaccinated people that got sick in an outbreak, you really want to know the percentages of vaccinated vs unvaccinated kids who got sick.

For example, in a school with 1,000 kids, you might be very surprised if six kids got a vaccine preventable disease, and three of them were vaccinated, leaving three unvaccinated.

Does that really mean that equal amounts of vaccinated and unvaccinated kids got sick?

I guess technically, but in the practical sense, it only would if half of the kids in the school were unvaccinated. Now unless they go to a Waldorf school, it is much more likely that over 90 to 95% of the kids were vaccinated, in which case, a much higher percentage of unvaccinated kids got sick.

Before we use a real world example, some terms to understand include:

  • attack rate – how many people will get sick when exposed to a disease
  • basic reproductive number or Ro – different for each disease, Ro basically tells you  just how contagious a disease is and ranges from about 1.5 for flu, 8 for chicken pox, and 15 for measles
  • vaccine coverage – how many people are vaccinated
  • vaccine efficacy – how well a vaccine works

You also need to know some formulas:

  • attack rate = new cases/total in group
  • vaccine coverage rate = number of people who are fully vaccinated / number of people who are eligible to be vaccinated
  • vaccine effectiveness = (attack rate in unvaccinated group – attack rate in vaccinated group) / attack rate in unvaccinated group x 100

Unfortunately, it is often hard to use these formulas in most outbreaks.

Why?

For one thing, it is hard to get accurate information on the vaccination status of all of the people in the outbreak. In addition to those who are confirmed to be vaccinated or unvaccinated, there is often a large number who’s vaccination status is unknown. And even if you know the vaccination status of everyone in the outbreak, it can be even harder to get the vaccine coverage rate or a neighborhood or city.

Outbreaks of Vaccine Preventable Diseases

Reports of measles outbreaks among highly vaccinated populations are from before we started doing a second dose in 1994.
Reports of measles outbreaks among highly vaccinated populations are from before we started doing a second dose of MMR… way back in 1994.

We know what starts most outbreaks.

And no, it’s not shedding

For example, with measles, it is typically an unvaccinated person who travels out of the country, returns home after they have been exposed but are still in their incubation period, and then exposes others once they get sick. And the great majority of folks in these measles outbreaks are unvaccinated.

Some examples of these outbreaks include:

  • the 2014 Ohio measles outbreak that started with two unvaccinated Amish men getting measles in the Philippines while on a missionary trip and ended up with at least 388 cases before it was over, almost all unvaccinated
  • a 2013 North Carolina measles outbreak with 22 cases started after an unvaccinated traveler had returned from India
  • an outbreak of measles in New York, in 2013, with at least 58 cases, tarted with an intentionally unvaccinated teen returning from a trip to London
  • a 2011 outbreak of measles in Minnesota, when an unvaccinated child traveled out of the country, developed measles, and returned to his undervaccinated community, causing the state’s largest measles outbreak in 20 years

But what about mumps and pertussis?

Those outbreaks are all among vaccinated kids, right?

Nope.

In one of the biggest mumps outbreak, in Arkansas, only 71% of people were up-to-date on their vaccines!

And keep in mind that while we do know that there are issues with waning immunity with some vaccines, you are still much more likely to become infected and get others sick if you are not vaccinated. And you will likely have a much more severe disease.

A 2013 pertussis outbreak in Florida is a good example that even with all the bad press it gets, the DTaP and Tdap vaccines work too. This outbreak was started by an unvaccinated child at a charter school with high rates of unvaccinated kids. About 30% of unvaccinated kids got sick, while there was only one case “in a person who reported having received any vaccination against pertussis.”

In another 2013 pertussis outbreak in Florida, this time in a preschool, although most of the kids were vaccinated, the outbreak started with “a 1-year-old vaccine-exempt preschool student.” And the classroom with the highest attack rate, was “one in which a teacher with a laboratory-confirmed case of pertussis who had not received a Tdap booster vaccination, worked throughout her illness.”

In outbreak after outbreak, we see the same thing, sometimes with deadly consequences – an unvaccinated child or adult triggers an outbreak and then a lot of unvaccinated folks get sick. Unfortunately, others get caught up in these outbreaks too, including those too young to be vaccinated, those who can’t be vaccinated because of true medical exemptions, and those whose vaccines may not have worked as well as we would have liked.

Get educated.

Vaccines are safe. Vaccines are necessary. Vaccines work.

What to Know About Vaccinated vs Unvaccinated in Outbreaks

Most outbreaks are started by someone who is unvaccinated, often after a trip out of the country, and the resulting outbreak will likely get many more unvaccinated than vaccinated folks sick.

More About Vaccinated vs Unvaccinated in Outbreaks

What Are the Benefits of the Flu Shot?

So that flu shot you got isn’t going to be 100% effective this year…

That doesn’t mean that you didn’t make a great decision getting your family vaccinated and protected! Or that you shouldn’t still take the time to go out and get a flu shot if you haven’t yet.

The flu vaccine works, even if it isn’t perfect.

Benefits of the Flu Shot

The benefits of the flu shot go far beyond just avoiding the flu.
The benefits of the flu shot go far beyond simply helping you avoid the flu.

What good is the flu shot if it doesn’t completely eliminate your risk of catching the flu?

How about the simple fact that even if doesn’t completely eliminate that risk 100%, a flu shot does decrease your risk of getting sick with the flu?

But it doesn’t end there.

Other benefits of a yearly flu shot include that it can:

  • reduce the risk of flu-associated death in children with underlying high-risk medical conditions by just over half (51%)
  • reduce the risk of flu-associated death in healthy children by just over two thirds (65%) – this is important, because despite what most people believe, many of the kids who die with the flu each year don’t have any underlying health problems
  • reduce how sick you get, even if you do get the flu, reducing “deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized flu patients.”
  • reduce the risk of the babies getting hospitalized in their first 6 months when pregnant moms got a flu shot
  • reduce asthma attacks leading to emergency visits and/or hospitalizations in people with asthma

Getting vaccinated can also reduce the risk that you get sick with the flu and get someone else sick.

Considering all of these benefits, it is hard to imagine why anyone wouldn’t get a flu shot, even in year’s when it might just be 60% or even 40% effective.

I mean, it isn’t like the flu shot is actually going to give you the flu or anything…

Have you gotten your flu shot yet this flu season?

What to Know About the Benefits of the Flu Shot

In addition to helping you avoid getting sick with the flu, getting a yearly flu shot has many other indirect benefits, so that even if you get the flu, it can help you avoid getting really sick and ending up in the hospital, ICU, or getting so sick that you don’t survive.

More on the Benefits of the Flu Shot

How Effective Is the Flu Vaccine?

The flu vaccine works.

How well does it work?

It depends…

How Effective Is the Flu Vaccine?

What does it depend on?

“The vaccine effectiveness of seasonal influenza vaccines is a measure of how well the seasonal influenza vaccine prevents influenza virus infection in the general population during a given influenza season.”

WHO on Vaccine effectiveness estimates for seasonal influenza vaccines

Is the flu virus that is going around the same strain that was picked to be in the flu vaccine?

Once upon a time, we didn't have flu vaccines to help keep us healthy.
Once upon a time, we didn’t have flu vaccines to help keep us healthy.

Has the flu virus drifted, even if it is the same strain that is in the flu vaccine, becoming different enough that your protective flu antibodies won’t recognize it?

Is the H3N2 strain of flu virus the predominate strain during the flu season? H3N2 predominant flu seasons are thought to be worse than others.

In general, the flu vaccine is going to be less effective in a season where there is a poor match between the circulating strain of flu virus that is getting people sick and the strain that is in the flu vaccine, especially if it is an H3N2 strain that has drifted.

That’s why, since the 2004-05 season, the average flu vaccine effectiveness has been about 41%.

How Effective Is This Year’s Flu Vaccine?

It’s probably also why, every year, we seem to hear the same questions:

  • Should I get a flu vaccine? – yes, definitely
  • Will we have enough flu vaccines? – while historically there have been some delays and shortages, we have a very good supply of flu vaccine this year, between 151 to 166 million doses
  • How effective is this year’s flu vaccine???

Unfortunately, we really won’t know the answer to that last question until this year’s flu season really gets going.

What about reports that the flu vaccine effectiveness will be as low as 10% this year?

It is important to note that those reports are not based on flu activity in the United States and it has been a long time since we have seen flu vaccine effectiveness that low – the 2004-05 flu season. That was the year that because of a drifted A(H3N2) virus, “only 5% of viruses from study participants were well matched to vaccine strains.”

The 10% number is instead based on reports of Australia’s flu season, in which early estimates found that the A(H3N2) component of the flu vaccine was only 10% effective. Importantly, the overall vaccine effectiveness was much higher. Including other strains, the flu vaccine in Australia was at least 33% effective this past year.

“In the temperate regions of the Southern Hemisphere, influenza activity typically occurs during April – September.”

CDC on Influenza Prevention: Information for Travelers

Couldn’t we see a drifted A(H3N2) virus this year?

Sure, especially since an A(H3N2) virus will likely be the dominant strain, but so far “data indicate that currently circulating viruses have not undergone significant antigenic drift.”

“It is difficult to predict which influenza viruses will predominate in the 2017–18 influenza season; however, in recent past seasons in which A(H3N2) viruses predominated, hospitalizations and deaths were more common, and the effectiveness of the vaccine was lower.”

CDC on Update: Influenza Activity — United States, October 1–November 25, 2017

Again, it is too early to predict how effective the flu vaccine will be, but based on an undrifted H3N2 virus that is matched to the vaccine, you might expect an effectiveness between 30 to 40%.

It might be less if theories about egg-adapted mutations are true and are a factor this year.

“…some currently circulating A(H3N2) viruses are less similar to egg-adapted viruses used for production of the majority of U.S. influenza vaccines.”

CDC on Update: Influenza Activity — United States, October 1–November 25, 2017

It is also important to keep in mind that vaccine effectiveness numbers from Australia and the United States don’t always match up.

For example, in 2009, Australia reported an interim flu vaccine effectiveness of just 9%, but in the United States, the flu vaccine ended up being 56% effective! On the other hand, in 2014, the flu vaccine worked fairly well in Australia, but vaccine effectiveness was found to be just 19% in the United States.

Vaccine Effectiveness by Year
Australia United States
2007 60% 2007-08 37%
2008 NE 2008-09 41%
2009 7% 2009-10 56%
2010 73% 2010-11 60%
2011 48% 2011-12 47%
2012 44% 2012-13 49%
2013 55% 2013-14 52%
2014  50% 2014-15 19%
2015  ?% 2015-16 48%
2016  ?% 2016-17 42%
2017 33% 2017-18 ?%

What does all of this mean?

Not much.

“This season’s flu vaccine includes the same H3N2 vaccine component as last season, and most circulating H3N2 viruses that have been tested in the United States this season are still similar to the H3N2 vaccine virus. Based on this data, CDC believes U.S. VE estimates from last season are likely to be a better predictor of the flu vaccine benefits to expect this season against circulating H3N2 viruses in the United States. This is assuming minimal change to circulating H3N2 viruses. However, because it is early in the season, CDC flu experts cannot predict which flu viruses will predominate. Estimates of the flu vaccine’s effectiveness against circulating flu viruses in the United States will be available later in the season.”

CDC on Frequently Asked Flu Questions 2017-2018 Influenza Season

The reports about what happened in Australia should not have made headlines beyond Australia.

As you should get your family vaccinated if you haven’t yet.

The Flu Vaccine Works

Getting a flu vaccine has many benefits with few risks and can:

  • reduce your chances of getting the flu
  • reduce the chances that your newborn gets the flu if you get your flu shot while pregnant
  • lead to milder symptoms if you do get the flu
  • reduce your risk of being hospitalized
  • reduce your risk of dying from the flu

And while it isn’t perfect, getting a flu vaccine is certainly better than remaining unprotected and simply taking your chances that you won’t get the flu and complications from the flu.

What to Know About Flu Vaccine Effectiveness

Although the effectiveness of the flu vaccine varies from year to year, depending on how well matched the vaccine is to circulating flu virus strains, which strains are dominant, and whether they have drifted, it is always a good idea to get vaccinated and protected.

More on Flu Vaccine Effectiveness

Myths About Vaccines and Breastfeeding

The American Academy of Pediatrics recommends “exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.”

They do not recommend breastfeeding as a substitute for getting vaccinated.

They also don’t recommend that anyone stop breastfeeding after their children are vaccinated.

These are just some of the myths that you might hear about vaccines and breastfeeding.

Myths About Vaccines and Breastfeeding

Breastfeeding does provide some immunity against infectious diseases.

Unfortunately, this type of passive immunity won’t keep your child from getting diseases like measles, pertussis, or the flu. Breast milk, which is high in IgA antibodies, can help protect against gastrointestinal diseases and some respiratory infections though.

And that is where the myth about the “recommendation” to stop breastfeeding comes in…

Why do anti-vaccine websites still post misinformation about fake recommendations to stop breastfeeding?
Why do anti-vaccine websites still post misinformation about fake recommendations to stop breastfeeding?

Actually, it was never a recommendation by any major health organization.

It was not a recommendation by the AAP, CDC, or even the WHO.

“Live oral rotavirus vaccines have been less immunogenic and efficacious among children in poor developing countries compared with middle income and industrialized countries for reasons that are not yet completely understood. We assessed whether the neutralizing activity of breast milk could lower the titer of vaccine virus and explain this difference in vitro.”

Moon et al on Inhibitory Effect of Breast Milk on Infectivity of Live Oral Rotavirus Vaccines

And they simply suggested that nursing mothers delay breastfeeding for up to an hour after their baby was vaccinated with an oral rotavirus vaccine. Don’t skip a feeding. Don’t stop breastfeeding. Don’t switch to formula.

“Rotavirus is the most common cause of severe diarrhea in children less than 5 years of age. Rotavirus disease is responsible for an estimated 527,000 deaths per year worldwide, with >85% of these deaths occurring in low-income countries.”

Moon et al on Inhibitory Effect of Breast Milk on Infectivity of Live Oral Rotavirus Vaccines

Why did they talk about breastfeeding at all?

They were simply looking for a way to boost the effectiveness of rotavirus vaccines in these countries, where rotavirus disease is still a big killer.

Unfortunately, in addition to the whole theory being turned into more propaganda by the anti-vaccine movement, further studies have shown that it likely doesn’t even work.

“Breastfed infants should be vaccinated according to the recommended schedule ”

CDC on General Recommendations on Immunization

What are other myths about vaccines and breastfeeding?

  • that breastfeeding is a substitute for getting vaccinated – it’s not – vaccines are necessary, even if you are breastfeeding your child
  • you can’t get vaccinated if you are breastfeeding – not true, unless you are looking to get a smallpox vaccine, which is contraindicated. Getting a yellow fever vaccine is discouraged if you are breastfeeding, but is not contraindicated if your are traveling to a high risk area.

Although it is currently not available in the United States, you can even get FluMist if you are breastfeeding.

What to Know Vaccines and Breastfeeding Myths

Why do anti-vaccine websites post misinformation about fake recommendations to stop breastfeeding and other myths about vaccines?

More on Myths About Vaccines and Breastfeeding

Vaccines Work

Most people understand that vaccines work.

“…for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”

Walter Orenstein, MD

And that they work well.

The Pre-Vaccine Era

Just consider that in the pre-vaccine era, there were:

  • up to 15,000 deaths and 200,000 diphtheria cases each year until the 1940s
  • an average of 175,000 cases of pertussis each year in the early 1940s
  • 1,118 deaths from pertussis in 1950
  • 467 deaths from pertussis in 1955
  • up to 20,000 cases of paralytic polio each year until the early 1950s
  • an average of about 186,000 cases of mumps each year before 1967
  • an average of 40 deaths a year from mumps in the 1960s
  • up to 500 deaths and 500,000 measles cases each year until the early 1960s
  • a rubella epidemic in 1964-65 that caused 12.5 million rubella virus infections and “resulted in 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 infants born with congenital rubella syndrome”
  • up to 20,000 cases of invasive H. influenzae (Hib) disease each year, with more than half of them having meningitis, and about 300 to 600 deaths, mostly children under age 2 years. In 1980, 45 children died with epiglottitis and there were an additional 222 deaths from Hib meningitis.
  • up to 11,000 hospitalizations and 100 chicken pox deaths each year until 1995
  • before 2000, up to 17,000 cases of invasive pneumococcal disease in children younger than 5 years each year, including 13,000 cases of bacteremia (blood infection) and 700 cases of pneumococcal meningitis, with 200 deaths.
  • just over 400,000 visits to the doctor and up to 272,000 visits to the emergency room, 70,000 hospitalizations and 20 to 60 deaths each year in children under age 5 years because of rotavirus infections until 2006

Although we are seeing more outbreaks of some of these diseases these days, it is important to remember that they in no way resemble the kinds of epidemics that we once saw before today’s vaccines were introduced.

And in addition to smallpox being eradicated, others have really been eliminated, like congenital rubella syndrome, diphtheria, neonatal tetanus, and polio. Still others are well controlled, including hepatitis A, hepatitis B, and Hib.

The Idea That Vaccines Don’t Work

Could it be that vaccines don’t work and that it was hygiene, sanitation, and better nutrition that caused the decline in many of these cases?

Of course not, but if they did, then why did pertussis cases decline in the 1940s and it wasn’t until the late 1960s and early 1970s that mumps started to decline.

“From the 1930s through the 1950s, state and local health departments made substantial progress in disease prevention activities, including sewage disposal, water treatment, food safety, organized solid waste disposal, and public education about hygienic practices (e.g., foodhandling and handwashing). ”

CDC on Achievements in Public Health, 1900-1999: Control of Infectious Diseases

That’s not to say that we didn’t see a big drop in mortality in nearly all conditions in the first half of the 20th century.

We did have big improvements in sanitation, nutrition, and health care that helped folks survive if they got sick. After all, this was the time that:

  • penicillin was discovered
  • testing could be done to detect and diagnose many infectious diseases
  • they began fortifying milk with vitamin D
  • we had the establishment of hospital blood banks

But even with all of these improvements, people continued to die of diphtheria, measles, and pertussis, etc., even if it wasn’t at 18th or 19th century levels.

Measles mortality was decreasing after the beginning of the 20th Century, but eventually leveled off to about 400 deaths each year in the pre-vaccine era.
Measles mortality was decreasing after the beginning of the 20th Century, but eventually leveled off to about 400 deaths each year in the pre-vaccine era.

In addition to the idea that better sanitation and nutrition got rid of vaccine-preventable diseases, another idea that anti-vaccine folks push is that these diseases disappear because we simply change their names after a vaccine is introduced.

So polio didn’t go away, it became acute flaccid paralysis and Guillian-Barré syndrome.

Measles became roseola.

Smallpox became monkey pox.

And pertussis became croup.

Of course, these ideas are silly.

If better sanitation and nutrition got rid of vaccine-preventable diseases, then why didn’t it get rid of all of them at the same time? And is it just a coincidence that chicken pox, rotavirus, polio, measles, hepatitis B, and Hib all started to decline at about the same time that a vaccine against each disease was introduced?

Also, why hasn’t hygiene, sanitation, and better nutrition helped RSV, HIV, West Nile virus and other non-vaccine preventable diseases disappear

And if we just change the names of diseases to prove that vaccines work, why don’t we change the name of the flu? Or why don’t we introduce an RSV vaccine that doesn’t work and then just change the name of RSV to something else?

Lastly, where are all of the people with monkey pox?

Vaccines Work

Vaccines aren’t perfect. We need boosters for some and are dealing with problems of waning immunity with others.

“The science is clear: The earth is round, the sky is blue, and #vaccineswork. Let’s protect all our kids. #GrandmothersKnowBest”

Hillary Clinton on Twitter

Vaccines aren’t 100% effective. That’s one of the reasons that intentionally unvaccinated people put all of us at risk.

Vaccines are safe though and work very well to protect us from vaccine-preventable diseases.

Without these vaccines, we would be seeing much larger outbreaks of measles, mumps, and pertussis, etc. that are harder to contain. We would also be seeing more deaths and other serious complications from these diseases.

What To Know About How Vaccines Work

Vaccines are safe, effective, and necessary. Vaccines work very well to protect us from the vaccine-preventable diseases that have now either been eliminated or are well controlled at much lower levels than they were at in the pre-vaccine era.

More About Vaccines Work

How Long Does Immunity from Vaccines Last?

Most vaccines provide long lasting protection.
Most vaccines provide long-lasting protection. Photo courtesy of Judy Schmidt and James Gathany.

One of the benefits of natural immunity is that after you get sick with a disease, you get life long immunity.

At least usually.

It is often a surprise to some people that some diseases don’t give life long immunity, most notably pertussis infections and tetanus, which typically doesn’t give any natural immunity at all.

How Long Does Immunity from Vaccines Last?

What about vaccines?

Do you get life long immunity after vaccines?

If you know about the issues of waning immunity with some vaccines, then you already know the answer. And even if you didn’t know that immunity from the mumps and pertussis vaccines can wear off, then you likely do know that you need a tetanus booster every 10 years, so that vaccine doesn’t give life long immunity.

How long is the protection from other vaccines?

  • the measles vaccine provides protection for at least 35 years
  • the hepatitis B vaccine provides protection for at least 20 years
  • the hepatitis A vaccine provides protection for at least 14 years
  • the chicken pox vaccine provides protection for at least 20 years
  • both the oral and inactivated polio vaccines provide long lasting protection
  • the rubella vaccine provides protection for at least 21 years
  • Gardasil provides protection for at least 8 years
  • the Hib vaccine provides protection for at least 9 years
  • like tetanus, the diphtheria vaccine provides protection for at about 10 years
  • the pneumococcal vaccine (Prevnar) provides protection for at least 5 years

Why do we say “at least” in so many cases?

In general, that’s how long these vaccines have been around. As time goes by, we will hopefully find that they last much longer.

What To Know About the Duration of Protection from Vaccines

Although some vaccines require boosters, most vaccines provide long-lasting protection.

More Information About Duration of Protection from Vaccines

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