The Future of Vaccination: Part 2 – Global, Community and Individual Challenges

In this video by VaccinesToday, experts from vaccine research and industry fields at the World Vaccines Congress 2013 in Lille, France are asked about their views on the future of vaccine research.

Global Challenges

Eradication of Polio

Only Pakistan, Nigeria and Afghanistan are currently considered endemic for polio because they have never eliminated native polio viruses. There has been a 99% reduction in the global incidence of polio since eradication efforts began in 1988, when there were 350 000 people affected with the disease. There are still a few hundred cases of wild polio virus-related paralysis each year, which occur both in endemic countries as well as in countries re-infected via importations.

Live attenuated oral polio vaccine (OPV) and inactivated polio vaccine (IPV) are being used to achieve eradication of wild polio virus. OPV is preferred for its low cost, ease of administration and community protection, but can rarely cause paralysis and regenerate wild-type polio strains. Therefore IPV, will have to replace OPV after eradication of wild polio virus is certified, in order to sustain eradication of all polioviruses. However, uncertainties remain related to IPV’s ability to induce intestinal immunity in populations where transmission of polio is mainly via the faecal–oral route.

The World Health Organisation (WHO), the United Nations Children’s Fund (UNICEF), Rotary International, the CDC and other organisations are leading the Global Polio Eradication Initiative (GPEI). This initiative has developed the Polio Eradication and Endgame Strategic Plan that aims to wipe out the last cases of polio from all causes by 2018.

There are 3 types of poliovirus. Because type 2 virus accounts for more than 95% of recent circulating vaccine-derived polio virus outbreaks and approximately 30% of vaccine-associated paralytic poliomyelitis cases, the currently used trivalent OPV which protects against types 1, 2 and 3, needs to be replaced with a bivalent OPV which protects against types 1 and 3. It is also recommended that all OPV using countries introduce at least one dose of IPV into routine immunisation schedules before the end of 2015. The plan is expected to cost US$5.5 billion but promises to yield up to US$25 billion in additional net benefits over the next 20 years.

Eliminating Measles from the Western Pacific

The Measles Regional Verification Commission has recently verified Brunei Darussalam, Cambodia and Japan as having achieved measles elimination. The three countries join Australia, Macao SAR (China), Mongolia and the Republic of Korea as countries and areas in the Western Pacific Region that have successfully eliminated measles. “Measles elimination is achievable in the Western Pacific Region. Increased commitment, funding and advocacy are all urgently required to immunise all children against measles, especially the most vulnerable in the hardest to reach communities,” said Dr Shin Young-soo, World Health Organization (WHO) Regional Director for the Western Pacific. With these great efforts, it is only a matter of time before measles is eliminated from developing countries.

measlescambodia

Here we discussed just two examples of current vaccination challenges and plans. For more information about what needs to be done, you can download WHO’s Global Vaccine Action Plan 2011-2020 here.

Community and Individual Challenges

In countries such as Australia and the US, where we have not seen the effects of vaccine-preventable diseases in a long time, parents often choose not to vaccinate their children out of fear of side effects or remain skeptical about vaccine ingredients and possible links to other diseases. It is vital that this ambivalence is addressed and parents are educated about the importance of vaccinating themselves and their children. There needs to be more funding to promote vaccination through school programs, health education, advertisements, and clinicians need to be educated on how to be better advocates. An example of something that can be done is: schools should introduce rules regarding proof of childhood vaccination at enrolment. Only through such effects can we fully eliminate these vaccine-preventable diseases forever.

Text References

Bandyopadhyay AS, Garon J, Seib K, Orenstein WA. Polio vaccination: past, present and future. Future Microbiol [Internet]. 2015 [cited 2015 Apr 7];31:1-18 [Epub ahead of print]. Available from: PubMed

World Health Organization, Western Pacific Region (PHL). Brunei Darussalam, Cambodia, Japan verified as achieving measles elimination [Internet]. Manila (PHL): World Health Organization, Western Pacific Region; 2015 Mar [cited 2015 Apr 7]. Available from: http://www.wpro.who.int/mediacentre/releases/2015/20150327/en/

Image References

WHO/B. Bayutas. Brunei Darussalam, Cambodia, Japan verified as achieving measles elimination [Internet]. Manila (PHL): World Health Organization, Western Pacific Region; 2015 [cited 2015 Apr 7]. [Figure], Measles Cambodia. Available from: http://www.wpro.who.int/mediacentre/releases/2015/20150327/en/

The Future of Vaccination: Part 1 – New Delivery Techniques & Vaccines

Vaccines have been a strong force in the global fight against infectious disease for more than 200 years. Thanks to vaccination, smallpox is gone from the world and polio is on the verge of eradication. However, the future presents us with continued challenges. Diseases such as HIV/AIDS and Malaria still do not have effective vaccines, and others are still prevalent in areas of the world where vaccines are unaffordable or there are not enough clinics and workers to deliver the vaccines. Current and future goals in vaccination include looking for vaccines with higher effectiveness, lower cost, and convenient delivery. Here are some exciting vaccination prospects and challenges that we will face in the future.

New Techniques in Vaccine Delivery

Microneedle patches

What if your yearly flu shot was a simple device that was sent to you in the mail, and you could administer it easily by yourself without the pain of a needle jab? Well, in five years from now, it could be a reality!

A new study has tested the use of a “microneedle patch” which could be used to deliver vaccines, and found the results to be quite promising. This patch consisted of 50 tiny needles, each less than 1 mm thick, arranged at the center of a thin, flexible foam pad about the size of an adult fingertip.

Prausnitz_MicroneedlePatch_Application

Participants in the study rated the pain of an intramuscular injection (needle jab into the muscle) to be 15 out of 100, while the microneedle patches were less painful, scoring 1.5 out of 100.

Besides being smaller and easier to use than the typical flu vaccine, the microneedle patch also does not need refrigeration, so it could potentially be made available for use outside of the doctor’s office or healthcare setting. Also, this means that the vaccine can be used in developing countries, where refrigeration can be a hindrance to vaccine delivery.

By using such a device, the number of patients waiting in clinics to get a flu shot could be reduced, which translate to lower healthcare costs for flu vaccination programs. More importantly, the convenience of this patch could increase flu immunisation rates, and could be used to deliver other vaccines too! Researchers plan to start a clinical trial in spring of this year, with the goal of making these patches available within 5 years.

Inhaled Vaccines: Nasal Spray

This nasal spray flu vaccine, also called ‘Live Attenuated Influenza Vaccine’ is approved for use in people from 2-49 years of age. All nasal spray flu vaccines for the 2014-2015 season provide protection against four flu viruses: an influenza A (H1N1) virus, an influenza A (H3N2) virus and two influenza B viruses.

equipnet_pharmaceutical_industry_nasal

There is evidence that the nasal spray flu vaccine may work better than a flu shot in younger children. A study showed that the nasal spray flu vaccine prevented about 50% more cases of flu than the flu shot in younger children. Therefore, the Centers for Disease Control and Prevention (CDC) now recommends the nasal spray vaccine for healthy children 2-8 years if it is immediately available.

Vaccines for Ebola

The Ebola virus was first identified in 1976. Because Ebola outbreaks were rare and past outbreaks have been controlled quickly, commercial vaccine manufacturers have not been urgent in advancing vaccines through clinical trials. That changed in 2014, when Ebola virus emerged at unprecedented levels in West Africa.


Ebola virus particles budding from African green monkey kidney cells.

Since the epidemic began in March 2014, there has been approximately 25 000 cases, and more than 10 000 deaths from the disease.

In 2014, vaccines previously tested only in animals were fast-tracked into Phase 1 clinical trials. There are currently four clinical trials in process for Ebola vaccine. In fact, phase 2 and 3 vaccine trials are already being planned. Trial participants will be those at high risk of contracting the disease, such as healthcare workers and family members of infected people.

 

Vaccines for Malaria

Unlike any infectious disease for which there is already a successful vaccine, malaria is transmitted via a parasite (Plasmodium species) that passes through multiple life stages, each of which presents a unique challenge to vaccine developers. Because the parasite can reproduce both asexually (in the host’s body) and sexually (in the mosquito vector’s gut), it has many advantages over the viruses and bacteria that we currently vaccinate against. Also, infection with malaria does not confer “sterile” immunity, which means that if you get malaria and you recover, you can be infected over and over again. However, future infections will probably be less severe. This is known as naturally acquired immunity and is why malaria is deadly for anyone who has never been infected before, such as children under five or foreign travellers.

A challenge with malaria’s “naturally acquired partial immunity” is that it does not last long. In fact, if someone has lived in Africa for his or her entire life and leaves for even a year, he or she will lose this immunity and once again be as vulnerable to malaria as someone who had never been infected. So to develop a malaria vaccine, we need to understand the mechanism of partial immunity and develop a vaccine based on that principle.

malaria

Basic life cycle of the Plasmodium species.

Because the parasite has three different life stages, there are three vaccine approaches currently being researched.

  • Pre-erythrocytic vaccines aim either to prevent the parasites from getting into the liver cells or to destroy infected liver cells. The greatest challenge for a pre-erythrocytic vaccine is the time frame, because the parasites reach the liver less than an hour after being injected by the mosquito. Therefore, the immune system does not have time to eliminate the parasite. One vaccine, the RTS,S vaccine, is currently in Phase III trials and is showing promise, with the latest results showing a 33-50% decrease in risk of malaria in children from 6 weeks to 17 months old.
  • Erythrocytic vaccines aim to stop the rapid invasion and asexual reproduction of the parasite in the red blood cells. Most of these vaccines are still undergoing Phase I or II trials.
  • Transmission blocking vaccines target the stage of sexual reproduction that occurs in the mosquito gut. They aim to kill the Anopheles mosquito vector, to stop further spread of the parasite.

These individual stage vaccines must show efficacy on their own before scientists can develop a vaccine combining multiple approaches, which many say is the next step. Although great progress has been made, vaccine development for malaria will continue to be an expensive and multidimensional effort.

Vaccines for HIV/AIDS

Human Immunodeficiency Virus (HIV) is a major global health concern not only because it can’t yet be prevented through vaccination, but also because infection is for life and the virus targets the immune system, infecting and killing CD4+ T-cells, making the infected more prone to other infections. (when the CD4+ T-cell count drops below a certain number).

While anti-retroviral treatments have greatly improved life expectancy and quality of life for people living with HIV, preventing HIV infection is still a primary goal, especially for developing countries that are hit hardest by the pandemic and cannot afford treatment. However, HIV has unique challenges that hinder vaccine development:

  • Lack of natural immunity to HIV – Since HIV infection is for life, researchers do not have a way to identify an immune response that would be effective against HIV.
  • Variability of HIV types – HIV mutates frequently plus many different subtypes of HIV exist.
  • Lack of correlates of protective immunity – Because no infected person has been able to naturally clear the virus, scientists do not know what protection from HIV would look like in a person in terms of antibody production and T-cells required for elimination of the virus.
  • No animal model that reliably predicts vaccine efficacy in humans

Some individuals are naturally able to prevent HIV from progressing to AIDS. Research into these individuals, known as the “elite controllers”, may help HIV vaccine development. Researchers are also looking into ways of generating antibodies against HIV. Studies have shown that some humans can produce antibodies capable of neutralising a wide range of HIV strains.  These antibodies provide an excellent target for vaccine discovery by highlighting weaknesses on the surface of the virus.

Cancer Vaccines

Just as our immune systems work to protect us from harmful viruses and bacteria, they also play a role in protect us from developing cancer. We already know that the hepatitis B vaccine can help prevent us from getting hepatitis B-induced liver cancer, and the human papillomavirus (HPV) vaccine can help to prevent the majority of cervical cancers.

But what if the cancer has already appeared?

The type of vaccine that is being designed to treat cancer is called a therapeutic cancer vaccine. There are two main types of these vaccines: autologous vaccines and allogeneic vaccines. Autologous vaccines use cells from a person’s tumour to make the vaccine, whereas allogeneic vaccines use laboratory grown donor cells. For this post, we will only discuss examples of some autologous vaccines. You can find more information about cancer vaccines here.

To make an autologous cancer cell cancer vaccine, cells from a person’s tumour are removed and treated in a way that makes them a target for the immune system. They are then injected into the body, where immune cells recognise them, attack them, and then do the same to other cancer cells in the body. The idea is that memory immune cells would be generated and be able to respond if cancer cells returned in the future. Several Phase 2 and Phase 3 trials of such autologous cancer cell vaccines are in process or have been completed, but none have been licensed yet.

Another approach to autologous cancer vaccines is to use a person’s own immune cells to make the vaccine. The immune cells are extracted from the blood and exposed to a tumour antigen, stimulated and then injected back into the body. The treated immune cells should then respond to the cancer cells expressing the target antigen. There is one autologous vaccine made from immune cells that is licensed in the US. Sipuleucel-t (Provenge®) is a prostate cancer vaccine. It has been shown in clinical trials to extend life for men with treatment-resistant metastatic prostate cancer.

The cancers that are the best candidates for vaccine therapy are those whose treatments are expensive, less effective, or involve the risk of serious side effects. For example, lung cancer, pancreatic cancer, and breast cancer are such candidates for vaccine therapy. Development of vaccines to treat cancer is certainly an exciting prospect. Future research and the results of clinical trials to be announced will provide us with more weapons in our fight against cancer.

Text References

Centers for Disease Control and Prevention (CDC) (US). Live Attenuated Influenza Vaccine [LAIV] (The Nasal Spray Flu Vaccine) [Internet]. Atlanta (GA): CDC; 2014 Aug [updated 2014 Sep 9; cited 2015 Apr 7]. Available from: http://www.cdc.gov/flu/about/qa/nasalspray.htm

National Institute of Biomedical Imaging and Bioengineering (US). DIY Vaccination: Microneedle Patch May Boost Immunization Rate, Reduce Medical Costs [Internet]. Bethesda (MD): U.S. Department of Health & Human Services, National Institutes of Health; 2014 Mar [cited 2015 Apr 7]. Available from: http://www.nibib.nih.gov/news-events/newsroom/diy-vaccination-microneedle-patch-may-boost-immunization-rate-reduce-medical

The College of Physicians of Philadelphia (US). Cancer Vaccines and Immunotherapy [Internet]. Philadelphia (PA): The College of Physicians of Philadelphia; 2014 Aug [cited 2015 Apr 7]. Available from: http://www.historyofvaccines.org/content/articles/cancer-vaccines-and-immunotherapy

The College of Physicians of Philadelphia (US). Ebola Virus Disease and Ebola Vaccines [Internet]. Philadelphia (PA): The College of Physicians of Philadelphia; 2014 Oct [cited 2015 Apr 7]. Available from: http://www.historyofvaccines.org/content/articles/ebola-virus-disease-and-ebola-vaccines

The College of Physicians of Philadelphia (US). Malaria and Malaria Vaccine Candidates [Internet]. Philadelphia (PA): The College of Physicians of Philadelphia; 2014 Jul [cited 2015 Apr 7]. Available from: http://www.historyofvaccines.org/content/articles/malaria-and-malaria-vaccine-candidates

The College of Physicians of Philadelphia (US). The Development of HIV Vaccines [Internet]. Philadelphia (PA): The College of Physicians of Philadelphia; 2014 Jul [cited 2015 Apr 7]. Available from: http://www.historyofvaccines.org/content/articles/development-hiv-vaccines

The College of Physicians of Philadelphia (US). The Future of Immunization [Internet]. Philadelphia (PA): The College of Physicians of Philadelphia; 2014 Jul [cited 2015 Apr 7]. Available from: http://www.historyofvaccines.org/content/articles/future-immunization

Image References

CDC/NIAID. Ebola Virus Disease and Ebola Vaccines [Internet]. Philadelphia (PA): The College of Physicians of Philadelphia; 2014 [cited 2015 Apr 7]. [Figure], Ebola virus particles budding from African green monkey kidney cells. Available from: http://www.historyofvaccines.org/content/articles/ebola-virus-disease-and-ebola-vaccines

EquipNet News. Researchers See Promise In Nasal Vaccines [Internet]. Canton (MA): EquipNet; 2011 [cited 2015 Apr 7]. [Figure], Nasal Vaccine. Available from: http://blog.equipnet.com/2011/04/19/researchers-see-promise-in-nasal-vaccines/

Meek, G. DIY Vaccination: Microneedle Patch May Boost Immunization Rate, Reduce Medical Costs [Internet]. Bethesda (MD): U.S. Department of Health & Human Services, National Institute of Biomedical Imaging and Bioengineering; 2014 [cited 2015 Apr 7]. [Figure], Four photos showing how to apply a microneedle patch. Available from: http://www.nibib.nih.gov/news-events/newsroom/diy-vaccination-microneedle-patch-may-boost-immunization-rate-reduce-medical

Michalakis Y, Renaud F. Malaria: Evolution in vector control. Nature [Internet]. 2009 [cited 2015 Apr 7];462(7271):298-300. Figure 1, Basic features of the Plasmodium life cycle. Available from: Nature Publishing Group

Vaccination: A Global Perspective

We have seen how detrimental vaccine preventable diseases can be and how an unvaccinated person can be a disease threat to others.

A short video below will further illustrate this point. Megan shared her frightening experience of caring for her ill baby who contracted measles from a visit to her paediatrician’s waiting room.

In an attempt to eliminate such outbreaks, several governments and health organisations have implemented policies on mandatory vaccinations.

Let’s begin by having a closer look at some of the previously successful policies:

1853 Mandatory vaccination against measles

Under the Act of Parliament in 1853, the British government implemented mandatory smallpox vaccination. People who refused to get vaccinated would incur a penalty or fine. In 1905, The U.S. Supreme Court in the case of Jacobson v. Massachusetts upheld the authority of various states to enforce compulsory smallpox vaccination laws.

Outcome: By 1900, smallpox had been eradicated from several countries in Northern Europe. Furthermore, the incidence of small pox decreased substantially to low levels for most industrialized counties by 1914

1997 Seven Point Plans – Australia

1. Initiatives for parents
Maternity immunisation allowance with childcare assistance and cash rebate
Provide incentives to parents for ensuring that their child’s immunisation schedule was up to date

2. A bigger role for GPs:
The General Practice Immunisation Incentives (GPII) Scheme (Medicare Australia)  rewards GP who monitor, promote and provide age appropriate immunisation service to children under the age of 7
GPII scheme was introduced on the basis that 93% of children had regular visits to their GP on an average of 7x a year.

3. Monitoring and evaluation of immunisation target

4. Immunisation days:
The Commonwealth and the States and Territories piloted a series of immunisation days (2 August, 4 October and 6 December 1997) which aimed to immunise areas with low coverage.
Over 4,600 individuals were vaccinated on these days, at a total of 195 sites.

5. Measles eradication:
In late 1998, a one-off school-based MMR vaccination was offered to all primary school aged children.
96% of school aged children between 5-12 years old were vaccinated during the campaign.

6. Education and research:
In 1997, an educational campaign was conducted via the mass media to target people from different cultural and linguistic backgrounds.

7. School entry requirement:
The Commonwealth and State and Territory Governments enforced school entry requirements which require mandatory provision of immunisation record during enrolment.
Allows identification of children who are up to date with their immunisation schedule
Allows for disease outbreak mitigation through quick identification and exclusion of unvaccinated students.
“Parents must provide certification of immunisation at the time of enrolment at a Victorian primary school. If school does not have documentation of immunisation status, either because not vaccinated or no documentation, the principal is required to exclude the child from school if an outbreak was to occur”

Outcome: 90% of children below the age of 5 and 93% of children below 2 years old are fully vaccinated.

Current Initiatives by World Health Organisation (WHO)

Global Vaccine Action Plan 2011 – 2020

The Global Vaccination Action Plan was organised by the World Health Organization and endorsed by the World Health Assembly in 2012. The plan, which is set from 2011-2020 is intended to improve health and expand the full benefits of immunization to all people, regardless of where they are born, who they are, or where they live in.

Through this, global herd immunity can be achieved.

Below are the 5 goals WHO wishes to fulfill by 2020:

goals

Maternal and Neonatal Tetanus (MNT) elimination

The MNT Elimination Initiative aims to reduce MNT cases to levels whereby the disease is no longer a major public health problem (less than one case of neonatal tetanus per 1000 live births in every district). In countries with poor sanitation, MNT are prevalent as unhygienic deliveries place mothers and new-borns at risk of contracting tetanus. Mortality rates are extremely high, especially when appropriate medical care is unavailable. Unlike polio and smallpox, tetanus cannot be fully eradicated as its spores are ubiquitous. However, MNT deaths can be easily prevented by clean delivery, cord care practices and/or by vaccinating pregnant mothers with tetanus vaccine.

Interesting vaccination policies across the globe 

Australia 

Under the National Immunisation Program (NIP), essential vaccines are available free of charge to eligible infants, children, adolescents and adults. NIP is internationally recognised as a strong and successful program, with a national average of over 90% coverage for most childhood vaccines. Australia’s achievements in immunisation have met international goals set by the World Health Organization (WHO) under the Global Immunization Vision and Strategy (GIVS).

European Union 

14 European countries have at least one mandatory policy for infant and early childhood vaccination, which often includes school entry vaccination requirements. Most of the policies are disease-specific and thus, not all vaccinations are compulsory.

Slovenia has one of the world’s most aggressive and comprehensive vaccination program. It encompasses mandatory vaccinations for 9 diseases (TB, tetanus, polio, pertussis, Haemophilus influenza type B, MMR, hepatitis B), whereby only medical exemptions are accepted.

Indonesia and Malaysia 

Both Indonesia and Malaysia have implemented nationwide school vaccination programs for decades in an attempt to vaccinate primary school children as a cohort. School nurses or team of medical staff from outside school will visit primary and secondary schools on annual basis to administer basic life vaccine. Children in Indonesia will receive diptheria vaccine in year 1, tetanus vaccine in year 2 and 3 and one shot of measles during their primary or secondary school. Therefore, most children would have received their essential vaccines by the time they finish secondary school.

Pakistan

goals

Polio virus currently affects 10 countries worldwide, and is endemic in three countries, including Pakistan. Following the re-emergence of polio cases in a country once thought to be on the verge of eradicating the deadly disease, the Pakistani government enforced mandatory polio vaccination in 2014.

“There is no mercy, we have decided to deal with the refusal cases with iron hands. Anyone who refuses (the vaccine) will be sent to jail,” Deputy commissioner Riaz Khan Mehsud said

The Pakistani government says it will set up mandatory immunisation points at airports and border crossings to help stop its polio outbreak from spreading.

United Kingdom

Currently in the UK, there is no legislation in place for mandatory vaccination or school entry vaccination. The absence of stringent vaccination policies, alongside the Wakefield controversy in late 1990s, has contributed to the dramatic rise in measles outbreaks. Thus, the UK has reinvigorated discussions pertaining to vaccination legislations, such as mandatory vaccination and school entry requirements.

United States

Mandatory school entry vaccination requirements are the primary strategy to increase vaccine uptake in all 50 states in USA. They are all state-based so variations exist between different states. Medical exemptions are allowed in all states, but only 48 states, other than Mississippi and West Virginia, allow for religious exemptions. 19 states allow parents to cite philosophical objections against childhood vaccination.

Strategies adapted by many countries to improve vaccination rates include:

Sending recall letters and updating record, increase vaccination settings closer to patients’ homes, expanding clinic hours, offering drop-in vaccination services (for example via home visiting service), integrate vaccination with health assessment (usually for hepatitis B).

Campaigns to raise awareness:

World Immunization Week 2015

World Immunization Week, which will be held from 24-30 April 2015, will signal “a renewed global, regional, and national effort to accelerate action to increase awareness and demand for immunization by communities, and improve vaccination delivery services.”

The theme of World Immunization Week 2015 is “Close the immunization gap”: the gap whereby there is still 1 in 5 children who do not receive basic vaccinations, as well as the existing gaps towards the targets set by the Global Vaccine Action Plan (GVAP).

National Infant Immunisation Week (NIIH) – USA

National Infant Immunization Week (NIIW) and Toddler Immunization Month (TIM) are annual observances that highlight the importance of routine vaccinations in protecting infants (younger than 2 years old) from vaccine preventable diseases. It will be held on the 18th-25th April 2015.

Text References

World Health Organization. Global Vaccine Action Plan 2011-2020 [Internet]. Geneva (CH): World Health Organization, 2013 [cited 2015 Apr 5]. Available from: http://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/en/

World Health Organization. Maternal and Neonatal Tetanus (MNT) elimination [Internet]. Geneva (CH): World Health Organization, [updated 2015 Mar 3; cited 2015 Apr 5]. Available from: http://www.who.int/immunization/diseases/MNTE_initiative/en/

National Centre for Immunisation. Summary of strategies to increase vaccination uptake in Australia [Internet]. Sydney (NSW): The University of Sydney, 2012 [cited 2015 Apr 5]. Available from: http://www.ncirs.edu.au/research/social/Strategies%20to%20improve%20vax%20uptake_Table1_FOR%20WEB.pdf

Department of Health and Ageing (AU). Immunise Australia: Seven Point Plan [Internet]. Melbourne(VIC): Australian Government; Department of Health and Ageing; [updated 2013 May 15; cited 2015 Mar 30]. Available from: http://www.health.gov.au/internet/immunise/publishing.nsf/Content/history-of-ia-prog

National Centre for Immunisation. School Entry Vaccination Requirements: Summary of the Evidence [Internet]. Sydney (NSW): The University of Sydney; Department of Health (AU), 2013 [cited 2015 Apr 5]. Available from: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/5A30200F245EF140CA257B890005A116/$File/school-entry-vaccination-provisions-13062013.pdf

BBC News. Pakistan to immunise people going abroad against polio [Internet]. BBC, 2014 [cited 2015 Apr 5]. Available from: http://www.bbc.com/news/world-asia-27292868

ABC News. Pakistan police arrest parents for refusing polio vaccine amid fresh immunisation campaign. ABC News [Internet]. 2015 Mar 3 [cited 2015 Apr 5]; Available from: http://www.abc.net.au/news/2015-03-03/pakistan-police-arrest-parents-for-refusing-polio-vaccine/6277204

World Health Organization. School based immunisation [Internet]. Geneva (CH): World Health Organization, [updated 2014 Nov 21; cited 2015 Apr 5]. Available from:http://www.who.int/immunization/programmes_systems/policies_strategies/school_based_immunization/en/

World Health Organization. School Immunisation Programme in Indonesia: 26 November – 5 December 2007 [Internet]. Geneva (CH): World Health Organization, 2008[cited 2015 Apr 5]. Available from: http://www.who.int/immunization/programmes_systems/policies_strategies/Indonesia-School-immunization.pdf

Image References:

World Health Organization. Global Vaccine Action Plan 2011-2020 [Internet]. Geneva (CH): World Health Organization, 2013 [cited 2015 Apr 5]. [Figure], Global Vaccine Action Plan 2011-2020. Available from: http://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/en/

World Health Organization. Global Vaccine Action Plan 2011-2020 [Internet]. Geneva (CH): World Health Organization, 2013 [cited 2015 Apr 5]. [Figure], Goals of the Decades of Vaccines (2011-2020). Available from: http://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/en/

The Guardian (AU). Pakistan jails 471 parents who refused to give polio vaccine to children [Internet]. The Guardian (AU), 2014 [cited 2015 Apr 5]. [Figure], A health worker gives a polio vaccine to a child in Peshawar, Pakistan. Available from: http://www.theguardian.com/society/2015/mar/02/parents-jailed-pakistan-refusing-children-polio-vaccinations

CartoonStock. Medical Service Cartoon [Internet]. London (UK): CartoonStock; 2014 [cited 2015 Mar 7]. [Figure]. That was quick! Available from: https://www.cartoonstock.com/directory/m/medical_service.asp

10 Important Reasons to be Vaccinated

Roald dahl

This quote is from a letter written in 1988 by Roald Dahl, the beloved children’s author, who wrote many memorable and brilliant stories such as ‘Charlie and the Chocolate Factory’ and ‘The Witches’. His daughter Olivia passed away from measles complications in 1962 because there was no measles vaccine at the time. Even though he penned this letter to parents around the world nearly thirty years ago, it is still very much as relevant today as it was in 1988.

As you have read in our previous post, the recent measles outbreak in Disneyland, California was a result of parents choosing not to vaccinate their children. The outbreak is ongoing and continuing to expand. More than 100 cases have now been confirmed in 14 states across the US, with 58 of them being linked to the original outbreak in Disneyland.

disney

If we have not convinced you yet, or you would like some clarification on the topic, here are ten important reasons why you should vaccinate.
The full version of Roald Dahl’s letter will be at the end of this post.

1. Vaccine-preventable diseases still exist in our world today.

The viruses and bacteria that cause illness and death still exist and can be easily passed on to those who are not protected by vaccines. In a time when we can travel across the world in just one day, it’s not hard to see just how easily diseases can travel too.

air travel

Air traffic in 24 hours. All of the yellow dots are planes and are equivalent to the diseases that may be traveling inside these planes!

2. By being vaccinated, you are protected against the disease without ever having to catch it from someone else first.

Vaccines contain the same antigens that cause diseases, but these antigens are either killed or weakened to the point that they cannot cause disease anymore. However, they are strong enough to make the immune system produce antibodies that lead to immunity against that specific disease. Basically, a vaccine is a safer substitute for you or your child’s first exposure to a disease. If you ever do get infected with the REAL pathogen, your previously primed immune system can respond quickly and effectively to prevent any disease occurring.

vaccines work

3. Vaccines are one of the most effective, safe and convenient preventative care measures available.

Scientists, researchers and doctors only approve vaccines to give to humans after a very long and careful review. Vaccines may involve some discomfort and may cause pain, redness, or tenderness at the injection site but this is nothing compared to the pain, discomfort, and trauma of the diseases these vaccines prevent. Serious side effects following vaccination, such as severe allergic reaction, are extremely rare. Here, the benefits unquestionably outweigh the risks.

risks

4. Immunisations can save your family time and money.

If your child is sick with a vaccine-preventable disease, they can be denied attendance at school or childcare. Sick children can also cause parents to lose time (and money) from work. These diseases have a costly impact, resulting in doctor’s visits, hospitalisations, and premature deaths. Also, some vaccine-preventable diseases can result in prolonged complications or disabilities and can be a financial burden because of lost time at work, medical bills or long-term disability care. Therefore, getting vaccinated against these diseases is a good investment. People who have a higher risk of getting infected because of their age, pregnancy, ethnicity or current diseases may be offered free yearly government vaccines. For example, in Western Australia, pregnant women can receive their yearly influenza immunisation for free. Once again, the benefits of vaccination definitely outweigh the costs in the long run.

A sign displayed outside a school in Florida, which strongly encourages all students to be vaccinated.

A sign displayed outside a school in Florida, which strongly encourages all students to be vaccinated.

5. Immunisation helps to protect the health of people who can’t receive vaccines.

This encompasses the concept of ‘Herd Immunity’, which was discussed in our previous post. This includes children who are too young to be vaccinated, people with severe allergies or weakened immune systems (e.g. cancer) and the few people who don’t respond to a particular vaccine. So if you get sick, your children, grandchildren, parents and the community are at risk. Remember that a vaccine-preventable disease that might make you sick for a couple of weeks could be deadly for your loved ones if it spreads to them. For example, adults are the most common source of the serious whooping cough infection in infants, which can be fatal.

kisses

6. Immunisations can save your child’s life.

Because of advances in medicine, your child can be protected against more diseases than ever before. Some diseases that once injured or killed thousands of children have been eliminated completely and others are close to eradication– primarily due to safe and effective vaccines. One example of the great impact that vaccines can have is the global elimination of smallpox and of polio in the United States. Polio was once America’s most-feared disease, as it caused death and paralysis in children. However, thanks to vaccination, today there are no reports of polio in the United States, and incidence is decreasing worldwide.

7. Vaccinations not only help you to avoid a certain disease, they protect you from getting its complications.

This is important for people with weakened immune systems such as the very young or elderly and people with chronic diseases such as diabetes, heart disease or lung disease. These people are more likely to develop complications from vaccine-preventable diseases, such as limb amputation, paralysis, hearing loss, convulsions, brain damage, and death. Other complications include reactivation of the disease when your immune system is weak. An example of this is infection with the varicella zoster virus. The first infection, which usually occurs in childhood, causes chicken pox. The virus can lie dormant in the nerves of the body for many years before becoming reactivated due to stress, old age or sickness, causing the painful shingles rash in adulthood.

chickenpox

A baby with varicella zoster infection causing chicken pox.

shingles

A man with shingles as a result of reactivation of the varicella zoster virus.

8. Being vaccinated can prevent you from getting sick overseas.

One of the preventative health measures that all travellers should take is to be immunised against certain diseases before travelling to another country. The World Health Organisation has listed the vaccines that are specifically for travellers:russia

  • Cholera
  • Hepatitis A
  • Hepatitis E
  • Japanese encephalitis
  • Meningococcal disease
  • Rabies
  • Tick-borne encephalitis
  • Typhoid fever
  • Yellow fever

These vaccines prevent diarrhoeal diseases (cholera, hepatitis) as a result of unhygienic food preparation and mosquito-transmitted diseases (yellow fever), which are prevalent in some developing countries. They may also prevent diseases transmitted by other animals (rabies, tick-borne encephalitis).

Also, in some countries you may be refused entry if you are not vaccinated, or you may be required to have the vaccination at the border. An example of this is the requirement of travellers to be vaccinated against yellow fever before entering yellow fever-endemic countries. Ask your doctor about travel vaccines and check with the embassy or consulate of the countries you are intending to visit. You can also visit The Travel Doctor website to find out what vaccines you need.

9. While some of us take vaccines for granted, people living in developing countries go to great lengths to get vaccinated.

In Australia and other developed countries such as the United States, vaccination is a normal practice that is often taken for granted, as parents question their effectiveness and safety. While these people are hesitant to vaccinate their children, women in developing countries are taking advantage of every opportunity they get to protect their children against disease.

Mothers in Africa line up to get their babies vaccinated against basic childhood diseases.

Mothers in Africa line up to get their babies vaccinated against basic childhood diseases.

For developing countries, vaccines are expensive and difficult to transport and store. There are not enough health workers to deliver them. We don’t realise how lucky we are to be given the life-saving option of vaccination.

melinda

 

10. By vaccinating yourself and your family, you are contributing to the eradication of vaccine-preventable diseases for future generations.

As you have read in our previous posts, vaccination has reduced, and in some cases, eliminated many diseases that killed or severely disabled people just a few generations ago. For example, children today don’t need to get smallpox shots anymore because the disease no longer exists in the world. Also, by vaccinating against rubella (German measles), the risk that pregnant women will pass this virus on to their baby has dramatically decreased, and associated birth defects such as deafness and blindness are no longer are seen in developed countries. If we continue vaccinating now, properly and completely, we can protect future generations. Parents in the future will be able to trust that the diseases of today will no longer be around to harm their children.

That concludes our post on ’10 Important Reasons to be Vaccinated’. Thanks for reading! We hope it has helped you to appreciate just how crucial it is to vaccinate. To bring the message home, here is the full version of Roald Dahl’s letter that we promised in the beginning of the post.

Measles: A Dangerous Illness

A letter to parents around the world, published in a pamphlet by the Sandwell Health Authority.
By Roald Dahl, 1988

Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

“Are you feeling all right?” I asked her.

“I feel all sleepy,” she said.

In an hour, she was unconscious. In twelve hours she was dead.

The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her.

On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles. I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.

It is not yet generally accepted that measles can be a dangerous illness. Believe me, it is. In my opinion parents who now refuse to have their children immunised are putting the lives of those children at risk. In America, where measles immunisation is compulsory, measles like smallpox, has been virtually wiped out.

Here in Britain, because so many parents refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunised, we still have a hundred thousand cases of measles every year. Out of those, more than 10,000 will suffer side effects of one kind or another. At least 10,000 will develop ear or chest infections. About 20 will die.

LET THAT SINK IN.

Every year around 20 children will die in Britain from measles.

So what about the risks that your children will run from being immunised?

They are almost non-existent. Listen to this. In a district of around 300,000 people, there will be only one child every 250 years who will develop serious side effects from measles immunisation! That is about a million to one chance. I should think there would be more chance of your child choking to death on a chocolate bar than of becoming seriously ill from a measles immunisation.

So what on earth are you worrying about? It really is almost a crime to allow your child to go unimmunised.

The ideal time to have it done is at 13 months, but it is never too late. All school-children who have not yet had a measles immunisation should beg their parents to arrange for them to have one as soon as possible.

Incidentally, I dedicated two of my books to Olivia, the first was ‘James and the Giant Peach’. That was when she was still alive. The second was ‘The BFG’, dedicated to her memory after she had died from measles. You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children.

Thanks for reading! Stay tuned for more posts on debunking vaccination myths, current programs and future research!

Text References

Centers for Disease Control and Prevention (CDC) (US). CDC Features: 10 Reasons To Get Vaccinated [Internet]. Atlanta (GA): CDC; 2015 Feb [cited 2015 Mar 28]. Available from: http://www.cdc.gov/features/adultvaccinations/

Centers for Disease Control and Prevention (CDC) (US). Why Are Childhood Vaccines So Important? [Internet]. Atlanta (GA): CDC; 2014 May [cited 2015 Mar 28]. Available from: http://www.cdc.gov/vaccines/vac-gen/howvpd.htm

Gebreyes, R (US). Melinda Gates Speaks Out Against The Anti-Vaccine Movement [Internet]. New York City (NY): The Huffington Post; 2015 Jan [updated 2015 Jan 23; cited 2015 Mar 28]. Available from: http://www.huffingtonpost.com/2015/01/22/melinda-gates-anti-vaccine_n_6519464.html

Gonzalez, RT (US). Read Roald Dahl’s Powerful Pro-Vaccination Letter (From 1988) [Internet]. New York City (NY): io9; 2015 Jan [cited 2015 Mar 28]. Available from: http://io9.com/read-roald-dahls-heart-rending-endorsement-of-measles-v-1682995322

National Foundation for Infectious Diseases (US). 10 Reasons To Be Vaccinated [Internet]. Bethesda (MD): National Foundation for Infectious Diseases; 2015 [cited 2015 Mar 28]. Available from: http://www.adultvaccination.org/10-reasons-to-be-vaccinated

Smartraveller (AU). Health [Internet]. Canberra (ACT): Australian Department of Foreign Affairs and Trade; 2011 Nov [updated 2014 Jul; cited 2015 Mar 28]. Available from: http://www.smartraveller.gov.au/tips/health.html

Vaccines.gov (US). Five Important Reasons to Vaccinate Your Child [Internet]. Washington (DC): U.S. Department of Health and Human Services; 2015 [cited 2015 Mar 28]. Available from: http://www.vaccines.gov/more_info/features/five-important-reasons-to-vaccinate-your-child.html

World Health Organization (WHO) (CH). International travel and health: Vaccines [Internet]. Geneva (CH): WHO; 2014 Apr [cited 2015 Mar 28]. Available from: http://www.who.int/ith/vaccines/en/

Image References

Berlier, M/PATH. Press kit: Improved meningitis vaccine for Africa could signal eventual end to deadly scourge [Internet]. Ferney-Voltaire (FR): Meningitis Vaccine Project; 2007 [cited 2015 Mar 28]. [Figure], Mothers wait to get their children vaccinated against basic childhood diseases in a region that expects to benefit from the new meningococcal conjugate vaccine, available within the next 2 years. Available from: http://www.meningvax.org/files/presskit-0706-improved-vaccine-photos.htm

Callahan, W. School interventions [Internet]. Hawthorne (FL): Vaccine Information; 2011 [cited 2015 Mar 28]. [Figure], This is in Florida where we have religious exemptions…can you say liars? Available from: http://www.vaccinetruth.org/school_interventions.htm

Daily Kos. Measles [Internet]. Berkeley, (CA): Tumblr; 2015 [cited 2015 Mar 28]. [Figure], Melinda Gates. Available from: https://www.tumblr.com/search/measles

Gonzalez, RT. Read Roald Dahl’s Powerful Pro-Vaccination Letter (From 1988) [Internet]. New York City (NY): io9; 2015 [cited 2015 Mar 28]. [Figure], Roald Dahl. Available from: http://io9.com/read-roald-dahls-heart-rending-endorsement-of-measles-v-1682995322

Kligensmith, M. How do vaccinations work? The science of immunizations [Internet]. Grand Rapids (MI): MLive.com; 2014 [cited 2015 Mar 28]. [Figure], How do vaccines work? Available from: http://www.mlive.com/news/index.ssf/2014/12/how_do_vaccinations_work_the_s.html

Kligensmith, M. How do vaccinations work? The science of immunizations [Internet]. Grand Rapids (MI): MLive.com; 2014 [cited 2015 Mar 28]. [Figure], What about the risks of vaccines? Available from: http://www.mlive.com/news/index.ssf/2014/12/how_do_vaccinations_work_the_s.html

MacKay, DJC. Air traffic in 24 hours [Internet]. Cambridge (UK): Department of Physics, University of Cambridge; 2009 [cited 2015 Mar 28]. [Figure], Air traffic in 24 hours. Available from: http://www.inference.phy.cam.ac.uk/sustainable/images/at/

MD Health. Chickenpox [Internet]. MD Health; 2015 [cited 2015 Mar 28]. [Figure], Chickenpox. Available from: http://www.md-health.com/Chickenpox.html

Stiglich, T. Other Voices: Anti-vaccination forces hurt us all [Internet]. McLean (VA): The Desert Sun; 2015 [cited 2015 Mar 28]. [Figure], TDS Other Voices Cartoon – Measles at Disneyland. Available from: http://www.desertsun.com/story/opinion/editorials/2015/01/23/voices-vaccination-fears/22219833/

Vara, C. Summer May Be Over But Billboard Sightings Continue [Internet]. Ann Arbor (MI): Shot of Prevention; 2012 [cited 2015 Mar 28]. [Figure], No kisses poster. Available from: http://shotofprevention.com/2012/09/06/summer-may-be-over-but-billboard-sightings-continue/

What does it look like? Shingles – what does it look like? [Internet]. What does it look like?; 2013 [cited 2015 Mar 28]. [Figure], Shingles. Available from: http://www.howdoeslooklike.com/shingles-what-does-it-look-like/

VACCINATION MYTHS DEBUNKED! Part 2

This is a continuation to the previous post regarding vaccination myths. After reading Part 1, we hope that parents will make decisions based on the pyramid on the left below:

asd

‘Improved living standards, not vaccination, have reduced infectious diseases’

Some argue that improved living standards, not vaccination, have contributed to the significant decline in infectious diseases over the last century.

While disease mortality reduced substantially due to improvements in living standards and healthcare quality, the benefits of vaccines are further illustrated by the drop in mortality cases from vaccine-preventable diseases such as diphtheria, pertussis, polio and measles.  Improvements in living conditions and healthcare alone are not capable of producing such results in a short period of time.

To support this argument, let’s include some statistics regarding the impact of vaccines on the incidence of infectious diseases:

1. Haemophilus influenza B (Hib) vaccine, which was first introduced into the Australian standard vaccination schedule in 1993, led to a significant decline in the number of Hib cases from 560 cases in 1992 to only 39 cases in 2006–2007. Sanitation levels and living conditions have been stagnant during this period of time and thus the decline in Hib cases cannot be attributed to living standards alone.

Incidence of Hib disease from 1990-2008 in U.S. The incidence of Hib disease began to decline dramatically, which coincide with introduction of conjugate Hib vaccines in 1987. Overall, Hib has declined by more than 99% compared with the pre-vaccine era.

2. Similarly, the introduction of conjugate meningococcal C vaccine in Australia during early 2003 has led to a decrease in incidence from 225 notified cases per year to only less than 15 cases per year.

‘My unvaccinated child should be of no concern to your vaccinated one’

Remember the measles outbreak in California’s Disneyland amusement park which spread across different states?

Have you ever wonder why SOME people get it but NOT others?

It is essential to maintain high vaccination rates within a population as it provides protection for people who are vulnerable to vaccine preventable diseases. This phenomenon is known as ‘herd immunity’. People who rely heavily on herd immunity include very young children, immunocompromised and elderly populations as they are unable to receive vaccination. Therefore, vaccination rates need to be high within a population for herd immunity to be effective.

Following the measles outbreak in California, researchers at Boston Children’s Hospital analysed case numbers reported by the California Department of Public Health to estimate vaccination rates of the affected areas. The vaccination rates for the areas were between 50%-86%, which is significantly lower than the 96%-99% rate required in providing herd immunity! This is an example on how a drop in vaccination rate can lead to re-emergence of diseases!

How would you feel if your child was the one responsible for measles epidemic in Disneyland?

mickey

It is crucial to understand that:
“Vaccination is not just a personal issue, it’s a community responsibility”.

‘Vaccines cause or spread the diseases they are supposed to prevent’

There are 7 types of vaccines available in the market: live-attenuated vaccines, inactivated vaccine, subunit vaccines, toxoid vaccines, conjugate vaccine, DNA vaccines and recombinant vector vaccines.

All of the vaccines, except for live-attenuated vaccine, contain inactivated pathogen materials which are incapable of causing the disease. On the other hand, live-attenuated vaccine contains an active and weakened form of the virus that it aims to protect from.

The MMR vaccine is an example of a live-attenuated vaccine. 5% of the population develop a rash after vaccination, which mimics the mild symptoms of measles. However, the vaccine protects individual against full blown complications such as measles encephalitis, which occur 1 in a million vaccinated children compared to 1 in 1000 children who have contracted measles!

In addition, the risk of transmitting vaccine virus is extremely rare. In the United States, out of 56 million doses of varicella vaccines distributed over 10 years, there have been only 6 documented cases of virus transmission from an immuno-competent person who is vaccinated.

Since cases of vaccine-preventable disease occur in those who have been vaccinated, vaccines are not effective

Remember like all other medications, no vaccine is 100% effective. While it’s still possible to get the disease you’ve been vaccinated against, disease severity and duration will most likely be reduced. Here is the explanation as to why not everyone benefits from vaccination.

To make vaccines safer than the disease, attenuated (weakened) or dead bacteria or virus are utilised. Due to variation in individual genetics, not all vaccinated people develop immunity. Most routine childhood vaccines are 85%-95% effective. Hence, for every 100 vaccinated individuals, 5-15 may not develop protective immunity.

But this does not mean that the vaccine is not effective. Upon exposure to measles, it is almost certain that 100 percent of all un-vaccinated children will be infected as compared to only 1% for children who received vaccination. Considering the high virulence associated with measles, there would probably have been many more cases if herd immunity was not present.

Interactive map showing the re-emergence of vaccine preventable diseases. Each circle on the map represents a local outbreak of a particular disease, while the size of the circle indicates the number of people infected in the outbreak.

As illustrated by this interactive map from the Council on Foreign Relations, several diseases that are easily prevented with vaccines have made a comeback in the past few years. The surge of these diseases coincides with changes in views about vaccine safety.

Even though the 1998 study (mentioned in Part 1) was found to be fraudulent, fears about vaccine safety have lingered around Europe and the United States till today.

As a result, viruses and bacteria have taken full advantage of the immunisation gaps!

asd

  • Measles has re-emerged as an endemic problem in Europe and U.S (2014)
  • Rising prevalence of whooping cough is becoming an issue in the U.S.
  • In 2011, a massive measles outbreak of 15,000 cases was reported in France
  • In 2012, there were more than 2,000 measles cases in the U.K

What about Africa? Why are there multiple outbreaks of vaccine preventable diseases? For many of them, the problem is due to poor accessibility to vaccines and not fears.

After reviewing both pros and cons of the issues revolving around vaccinations, which side are you on?

If you are still unsure about why vaccination is so important, maybe this video can enlighten you

Text References:

Majumder MS, Cohn EL, Mekaru SR, Huston JE, Brownstein JS. Substandard Vaccination Compliance and the 2015 Measles Outbreak. JAMA Pediatr [Internet]. 2015 [cited 2015 Mar 30]; 5(4):323-70. Available from: Medline

Council on Foreign Relations. Vaccine-Preventable Outbreaks: Maps [Internet]. New York City (NY): Council on Foreign Relations; 2015 [cited 2015 Mar 30]. Available from: http://www.cfr.org/interactives/GH_Vaccine_Map/index.html#map

Department of Health and Ageing (AU). Myths and Realities- Responding to arguments against vaccination: A guide for providers [Internet]. Melbourne(VIC): Australian Government; Department of Health and Ageing; 2013 [cited 2015 Mar 30]. Available from: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/1FC63A2886238E6CCA2575BD001C80DC/$File/full-publication-myths-and-realities-5th-ed-2013.pdf

Image references:

Laika’s medLibLog. EBM pyramid [Internet]. Worpress.Org; 2008 [cited 2015 Mar 30]. [Figure], Pyramid. Available from: https://laikaspoetnik.wordpress.com/2008/09/26/time-to-weed-the-ebm-pyramids/

Centers for Disease Control and Prevention (US). Haemophilus influenza type B [Internet]. Atlanta(GA): Centers for Disease Control and Prevention; 2012 [cited 2015 Mar 30]. [Figure], Incidence* of Invasive Hib Disease, 1990-2009. Available from: http://www.cdc.gov/vaccines/pubs/pinkbook/hib.html

Centers for Disease Control and Prevention (US). Measles Cases and Outbreaks [Internet]. Atlanta(GA): Centers for Disease Control and Prevention; 2014 [cited 2015 Mar 30]. [Figure], Measles Cases and Outbreaks. Available from: http://www.cdc.gov/measles/cases-outbreaks.html

Parasite Ecology. Vaccination Coverage and Herd Immunity [Internet]. Worpress.Org; 2014 [cited 2015 Mar 30]. [Figure], Life without vaccination: a sad story. Available from: https://parasiteecology.wordpress.com/2014/03/26/vaccination-coverage-and-herd-immunity/

Vara C. Disneyland Measles Outbreak: Should You Be Concerned [Internet]. Shot of Prevention: News and Views on Vaccines; 2015 Jan [cited 2015 Mar 30]. [Figure], Vaccinate your baby. Available from: http://shotofprevention.com/?s=why+worry+about+the+unvaccinated

The Cagle Post. Pat Bagley: Anti Vaccine Reunion Tour [Internet]. Santa Barbara (CA): Cagle Cartoon Inc; 2013 [cited 2015 Mar 30]. [Figure]. Anti Vaccine Reunion Tour. Available from: http://www.cagle.com/2013/11/anti-vaccine-reunion-tour/

VACCINATION MYTHS DEBUNKED! Part 1

Without a doubt, vaccination has been proven to be one of the most effective health measures to prevent disease worldwide, alongside proper sanitation and antibiotics. However, its routine use on healthy individuals for disease prevention raises concerns regarding safety. It is convenient for the public to place their attention on the risks of vaccination; especially when the detrimental effects of vaccine-preventable diseases are no longer prominent.

Parents who do not vaccinate their children often have deep concerns pertaining to vaccine safety, particularly of the risk of childhood developmental disorders. This influences how parents weigh up the risks and benefits of vaccination. At the end of the day, all parents want the best for their children. Therefore, it is crucial to provide factual data in response to the common concerns and myths revolving around vaccinations.

Vaccines are unsafe, they cause autisms and other disorders

The Measles, Mumps and Rubella (MMR) vaccine DOES NOT cause autism or inflammatory bowel disease (IBD). This false theory was first proposed by a group of researchers from United Kingdom (UK) in 1998. They suggested that the measles virus invades the gut and results in a new variant of inflammatory bowel syndrome (IBD). In addition, they hypothesized that the virus contributes to developmental disorders such as autism, or worsening of symptoms in children previously diagnosed with autism, so-called ‘regressive autism’.

This theory generated a lot of media attention. Thorough investigations have revealed the original data to be fraudulent:

1. Study participants were recruited through anti-MMR campaigners, and the study was commissioned and funded for planned litigation
2. Research findings were manipulated to favour their hypothesis

This study, as a result, was retracted from the Lancet journal that it was published in, and the lead author (Andrew Wakefield) lost his license to practice medicine.

The World Health Organisation, American Academy of Paediatrics, the British Chief Medical Officer, the UK Medical Research Council and Institute of Medicine have concluded no association between MMR vaccine and development of autism or IBD.

So why do the public still insist that the MMR vaccine causes autism?

Numerous vaccines are given to children in their first year of life, just when a lot of developmental changes are occurring. This overweighing of negative outcomes is a well-known psychological fact called “negativity bias”. If developmental disorders emerge around the time a vaccine is given, it’s convenient to place the blame upon vaccinations. However, the majority of problems thought to be related to vaccination are actually NOT due to the vaccine itself!

Indeed, the number of new cases of autism has been on the rise, but this is largely or completely due to a more effective diagnosis.

‘Vaccines contain toxic additives’

Yes, some vaccines do contain additives such as adjuvants, preservatives and formaldehyde. But are they toxic? No.  Let’s have a look at the explanation below.

Adjuvants, commonly aluminium salts, are added in certain vaccines to increase efficacy and enhance the immune response. In fact, aluminium levels from these vaccines are safe and lower than those from dietary intake or medications such as antacids! They are well below harmful levels indicated by organisations such as the United States Agency for Toxic Substances and Disease Registry. A systematic review, which looked into available studies on aluminium-containing vaccines, found no evidence of significant or long-term adverse effects in children. Common side effects include transient redness and swelling of skin.  However, the benefits of these vaccines far outweigh the associated “risks”.  Based on the 2 pictures below, which one would you rather get?

Reaction to vaccine: redness and swelling

Indian boy with polio

Preservatives containing thiomersal (a mercury compound) are commonly used in multi-dose vaccines (vaccine containing more than one dose of medication) to prevent contamination from bacterial and fungal growth. While preservative-free single-use vaccines are now widely produced in developed countries such as Australia and USA, thiomersal-containing vaccines are still utilised in certain developing nations. WHO, alongside other studies, have concluded that there is no evidence of associated risks in vaccines containing thiomersal.

Formaldehyde is used in the production of some vaccines to inactivate toxins from bacteria and viruses. But did you know that a pear contains around 50 times more formaldehyde than is found in any vaccine?

‘Vaccines weaken the immune system’

It is without a doubt that the current vaccination schedule may seem daunting to some! A child can receive up to 23 shots by 18th months and 6 shots during a single doctor visit! Hence, it is not unusual that parents may have concerns pertaining to how vaccines may interfere with a child’s developing immunity. This is often a reason to why parents refuse to vaccinate their children.

However, this should be the least of your worries. Instead of weakening the immune system, vaccines work by strengthening our defence mechanism against specific diseases through the production of antibodies.

But how important is it to get vaccinated?

Newborn babies are prone to many serious infections as their immune systems are still maturing. As such, they have to rely on the mother’s antibodies to prevent neonatal infection. This is why maternal vaccination is extremely crucial during pregnancy!

‘Vaccines overwhelm the immune system’

Vaccines contain a significantly small amount of antigens compared to the amount of bacteria children are exposed to in their daily lives, from the food they eat to the dust they breathe. Hence, vaccines DO NOT overwhelm the immune system.

 ‘Vaccines cause or worsen asthma and allergies’

There is no evidence that vaccines cause or worsen allergic diseases such as asthma or eczema. In fact, it is crucial that children with asthma receive all recommended vaccines as contracting respiratory related diseases such as pertussis or influenza can worsen the condition.

Some vaccines contain gelatin, yeast and egg protein which have a low risk of allergic reaction to some people. For example, the risk of anaphylaxis (a severe, life-threatening allergic reaction) after a single vaccine dose has been estimated to be less than 1 in a million. Children or adults with most food or environmental allergies can be safely vaccinated.

‘Infectious diseases, like chicken pox, are not serious’

“Vaccines are a victim of their own success, leading us to forget just how debilitating preventable diseases can be” – Unknown.

In today’s society, we are privileged to not witness the debilitating effects of vaccine preventable diseases such complete paralysis from polio and permanent brain damage from measles. Hospital wards today are no longer filled with iron lung machines. This is all thanks to the development of vaccines.

It is true that diseases such as chicken pox can be considered as mild and self-limiting. However, chicken pox can be fatal when it infects children or adults who are immune-compromised. The Varicella Zoster Virus (chicken pox virus) can also reactivate later in life to cause painful skin lesions known as shingles. Although not 100% effective, varicella vaccine demonstrates protective mechanisms against shingles and lowers the risk of contracting the disease.

More to come in part 2! STAY TUNED!

Text references:

Baumeister RF, Bratslavsky E. Bad is stronger than good. Rev Gen Psychol [Internet]. 2001 [cited 2015 Mar 20]; 5(4):323-70. Available from: Medline Gerber JS, Offit PA. Vaccines and Autism: A Tale of Shifting Hypotheses. Clin Infect Dis [Internet]. 2009 [cited 2015 Mar 20]; 48(4):456-61. Available from: Medline Department of Health and Ageing (AU).

Myths and Realities- Responding to arguments against vaccination: A guide for providers [Internet]. Melbourne(VIC): Australian Government; Department of Health and Ageing; 2013 [cited 2015 Mar 20]. Available from: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/1FC63A2886238E6CCA2575BD001C80DC/$File/full-publication-myths-and-realities-5th-ed-2013.pdf

Oxford Vaccine Group. Vaccine Ingredients [Internet]. Oxford (UK): University of Oxford; 2015 [cited 2015 Mar 20]. Available from: http://www.ovg.ox.ac.uk/vaccine-ingredients

Centers for Disease Control and Prevention (US). Varicella Safety – Varicella Chickenpox [Internet]. Atlanta(GA): Centers for Disease Control and Prevention; 2014 [cited 2015 Mar 20]. Available from: http://www.cdc.gov/vaccinesafety/vaccines/varicella/

Deer B. How the case against the MMR vaccine was fixed. BMJ [Internet]. 2011 [cited 2015 Mar 20]; (342):5347. Available from: Medline

Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine [Internet]. 2014 [cited 2015 Mar 20]; 32(29):3623-9. Available from: ScienceDirect

World Health Organization (WHO) (CH). Biologicals: Thiomersal [Internet]. Geneva (CH): WHO; 2014 [cited 2015 Mar 20]. Available from: http://www.who.int/biologicals/areas/vaccines/thiomersal/en/

Image References:

Acrylics and Dinosaurs. The truth about vaccine [Internet]. Los Angeles (CA): Acrylics and Dinosaurs; 2013 [cited 2015 Mar 20]. [Figure], Why? Because They Save Lives. Available from: http://www.bridgetgongol.com/2013/09/the-truth-about-vaccines.html

BabyCenter. Vaccination Reaction [Internet]. San Francisco (CA): Baby Center L.L.C; 2012 [cited 2015 Mar 20]. [Figure],This is what her arm looks like today. Available from: http://community.babycenter.com/post/a35593726/vaccination_reaction

Global Polio Eradication Initiative. Polio and prevention [Internet]. Geneva (CH): The Global Polio Eradication Initiative; World Health Organisation; 2010 [cited 2015 Mar 20]. [Figure], An Indian boy’s legs are shrunken from paralysis caused by polio. Available from: http://www.polioeradication.org/Polioandprevention.aspx

Organic Facts. Health Benefits of Pears [Internet]. Organic Information Service Pvt Ltd; 2013 [cited 2015 Mar 20]. [Figure]. Available from: https://www.organicfacts.net/health-benefits/fruit/pears.html

MontyFuse4. Immunisation [Internet]. FuseLabs; 2010 [cited 2015 Mar 20]. [Figure], Be Wise: Immunise. Available from: az14597.vo.msecnd.net Pixgood Galleries. Chickenpox cartoon [Internet]. Pixgood; 2010 [cited 2015 Mar 20]. [Figure], Chickenpox cartoon. Available from: http://pixgood.com/chicken-pox-cartoon.html

Vaccination: Numbers to Note

Here’s what vaccination has done for global health so far…

350 000

The estimated number of worldwide polio cases in 1988. This number is now 482, a reduction of more than 99% as of 2013 thanks to childhood vaccination campaigns. In fact, according to Unicef, polio is on the verge of eradication.

polioChildren with polio at the Cheshire Home for Handicapped Children, Freetown, Sierra Leone.

787 000

The number of newborn babies that died from tetanus in 1988. This number has decreased by 94% since the development of tetanus immunisation.

3 MILLION

The number of deaths from diphtheria, tetanus, whooping cough and measles prevented each year by vaccination.

vaccination happyEvery year, vaccines save the lives of 2-3 million children.

15.6 MILLION

The number of measles deaths prevented by measles vaccination during 2000-2013 worldwide, a 75% decrease.

112 MILLIONtdap

The number of infants vaccinated with 3 doses of DTP (Diptheria, Tetanus, Pertussis) in 2013.

However, despite major progress, many of the world’s children still do not have access to the full potential of immunisation. There are still millions of children who aren’t protected against these deadly infectious diseases.

 

1.5 MILLION

The total number of children under the age of five who died from diseases preventable by vaccines currently recommended by World Health Organization.

Number of child deaths from:

  • Haemophilus influenza type B: 199 000
  • Diptheria: 2500
  • Pertussis: 195 000
  • Measles: 122 000
  • Neonatal tetanus: 59 000
  • Tetanus (non-neonatal): 12 000
  • Pneumococcal disease: 476 000
  • Rotavirus: 453 000

boy

21.6 MILLION

The number of children in the world under the age of one who failed to receive a single dose of measles-containing vaccine as of end-2013.

  • Nine out of ten of these children will be infected if exposed to the virus – that’s over 19 million children at risk of developing measles.
  • In populations with high levels of malnutrition and a lack of adequate health care, up to 10% of measles cases result in death.
  • The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea, dehydration, ear infections, or severe respiratory infections such as pneumonia.
  • There is no specific treatment against the measles virus. The best policy is prevention!

    measles rashMeasles rash on a child’s back.

somaliaA child in Somalia who is suffering from measles infection.

21.8 MILLION

The number of children in the world under the age of one who did NOT receive three doses of DTP vaccine as of end-2013. That’s 1 in 5 children who are missing out on a life-saving vaccine.

The majority of these children live in developing countries such as Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Mexico, Nigeria, Pakistan, Vietnam and South Africa. Therefore, efforts to raise global immunisation levels will require a strong focus on these countries.

piGlobal distribution of the number of children who did not receive three doses of DTP-containing vaccine during 2013 (in millions).

Vaccines are often too expensive for the world’s poorest countries. Vaccine supply shortages and a lack of trained health workers contribute to this disparity in immunisation rates. Also, unreliable transportation systems and storage facilities make it difficult to preserve the vaccines that require refrigeration.

1

One 4 week-old baby has recently passed away in our hometown Perth, Western Australia from whooping cough, also known as pertussis. Baby Riley was too young to have started the infant vaccination program that could have protected him from the disease, and probably caught the disease from someone who was unvaccinated. This was the first death from the disease in Western Australia since 2011. See the news article here.

One death from a vaccine-preventable disease is one too many. In honour of baby Riley, please sign this petition to make Whooping cough (Pertussis) immunisations and boosters for Australian adults free or of minimal charge, get yourself and your children immunised, and urge your friends and family to do the same. If you are not from Australia, you could sign or create a petition in your own hometown or country.

What is being done about Global Vaccination?banner

World Health Organisation’s (WHO) World Immunisation Week is celebrated in the last week of April (24-30) and aims to promote vaccine use to protect people of all ages against disease.

This year, World Immunisation Week will be signalling a renewed global, regional, and national effort to increase the awareness and demand for immunisation by communities, and improve vaccination delivery services.gap poster

This year’s campaign will focus on closing the immunisation gap and reaching equity in immunisation levels as outlined in the Global Vaccine Action Plan.

This plan – endorsed by the World Health Assembly in 2012 ― is a framework to prevent millions of deaths by 2020 through universal access to vaccines for people in all communities.

Aims of the Global Vaccine Action Plan:

  • To strengthen routine immunisation to meet vaccination coverage targets
  • To accelerate control of vaccine-preventable diseases with polio eradication as the first milestone
  • To introduce new and improved vaccines
  • To increase research and development for the next generation of vaccine technology

Your gift can save children’s lives by providing vaccines to prevent them from measles, polio and so on. You can help. Click here to donate to World Vision’s vaccination program. You can also donate to UNICEF – for just $18 you can help prevent measles for 50 children.

What you can do to protect yourself and those around you:

  • Know what vaccines are available to protect against disease
  • Be motivated to check your vaccination status and that of your family and friends
  • Get the vaccines you need to protect yourself and your family from your local health practitioner
  • Be up to date with yearly vaccinations (e.g. seasonal flu vaccine)
  • Spread the word about vaccinations!

happy boy

Thanks for reading our post – we hope you have learned something new, and now have a greater understanding of the current situation in global vaccination. Keep an eye out for our next post – one for the skeptics and the anti-vaxxers. We tell you some reasons why people choose not to vaccinate, and why anti-vaccination is a dangerous threat to the health of mankind. See you then!

Text References

Fact sheet: Measles [Internet]. Geneva (CH): World Health Organization (CH); 2015 Feb [cited 2015 Mar 14]. Available from: http://www.who.int/mediacentre/factsheets/fs286/en/

Gates Foundation (WA). Vaccine Delivery [Internet]. Seattle (WA): Bill and Melinda Gates Foundation; 2015 [cited 2015 Mar 15]. Available from: http://www.gatesfoundation.org/what-we-do/global-development/vaccine-delivery

Global Health Observatory Data (CH). Immunization [Internet]. Geneva (CH): World Health Organization; 2015 Feb [cited 2015 Mar 14]. Available from: http://www.who.int/gho/immunization/en/

The United Nations Children’s Fund (UNICEF) Data (US). Immunization – Current Status and Progress [Internet]. New York City (NY): UNICEF; 2015 Jan [cited 2015 Mar 14]. Available from: http://data.unicef.org/child-health/immunization

World Health Organization (WHO) (CH). 10 facts on immunization [Internet]. Geneva (CH): WHO; 2012 Apr [updated 2014 Mar 29; cited 2015 Mar 14]. Available from: http://www.who.int/features/factfiles/immunization/en/

World Health Organization (WHO) (CH). Global Immunization Data [Internet]. Geneva (CH): WHO; 2014 Jul [updated 2014 Aug 1; cited 2015 Mar 14]. Available from: http://www.who.int/immunization/monitoring_surveillance/global_immunization_data.pdf

World Health Organization (WHO) (CH). Tetanus [Internet]. Geneva (CH): WHO; 2014 Dec [cited 2015 Mar 14]. Available from: http://www.who.int/immunization/diseases/tetanus/en/

World Health Organization (WHO) (CH). World Immunization Week: 24-30 April 2014 [Internet]. Geneva (CH): WHO; 2014 Apr [cited 2015 Mar 15]. Available from: http://www.who.int/campaigns/immunization-week/2014/event/en/

World Health Organization (WHO) (CH). World Immunization Week 2015: Close the immunization gap [Internet]. Geneva (CH): WHO; 2015 Jan [cited 2015 Mar 15]. Available from: http://www.who.int/campaigns/immunization-week/2015/event/en/

Image References

De Souza, C/AFP/Getty Images. Is The Disneyland Measles Outbreak A Turning Point In The Vaccine Wars? [Internet]. Jersey City (NJ): Forbes; 2015 [cited 2015 Mar 15]. [Figure], A child in Somalia with measles. Available from: http://www.forbes.com/sites/matthewherper/2015/02/04/the-disneyland-measles-outbreak-is-a-turning-point-in-the-vaccine-wars/

Santos, AJ. 10 reasons vaccines are the best protector of human life [Internet]. Seattle (WA): PATH; 2014 [cited 2014 Mar 15]. [Figure], Schoolgirl with a broad smile receives a shot in her upper arm as her schoolmates watch. Available from: http://www.path.org/blog/2014/04/10-reasons-vaccines-are-best/

Singh, P/Agence France-Presse/Getty Images. Seattle Group Paying F.D.A. for Work on a Pneumococcal Disease Vaccine [Internet]. New York City (NY): The New York Times; 2010 [cited 2015 Mar 15]. [Figure], Pneumococcal Disease. Available from: http://www.nytimes.com/2010/02/02/health/02glob.html?_r=0

Watney Collection/Phototake. Slideshow: Childhood Illnesses Every Parent Should Know [Internet]. Atlanta (GA): WebMD; 2011 [cited 2015 Mar 15]. [Figure], Measles. Available from: http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/childhood_illnesses_slideshow/phototake_rm_photo_of_measles_on_childs_back.jpg

Vaccine News Daily. Tdap vaccine declared safe for adults over 65 [Internet]. Chicago (IL): Vaccine News Daily; 2012 [cited 2015 Mar 15]. [Figure], Tdap vials. Available from: http://vaccinenewsdaily.com/medical_countermeasures/320913-tdap-vaccine-declared-safe-for-adults-over-65/

World Health Organization. Close the immunization gap [Internet]. Geneva (CH): World Health Organization, 2015 [cited 2015 Mar 15]. [Figure], A child being vaccinated. Available from: http://www.who.int/campaigns/immunization-week/2015/en/

World Health Organization. Close the immunization gap [Internet]. Geneva (CH): World Health Organization, 2015 [cited 2015 Mar 15]. [Figure], World Immunization Week 2015 Banner. Available from: http://www.who.int/campaigns/immunization-week/2015/en/

World Health Organization. Close the immunization gap [Internet]. Geneva (CH): World Health Organization, 2015 [cited 2015 Mar 15]. [Figure], World Immunization Week 2015 Poster. Available from: http://www.who.int/campaigns/immunization-week/2015/en/

World Health Organization. Polio Photos [Internet]. Saint Paul (MN): Immunization Action Coalition; 2007 [cited 2014 Mar 15]. [Figure], Cheshire Home for Handicapped Children, Freetown, Sierra Leone. Available from: http://www.vaccineinformation.org/polio/photos.asp

World Health Organisation/The United Nations Children’s Fund. Immunization – Current Status and Progress [Internet]. New York City (NY): The United Nations Children’s Fund; 2013 [cited 2015 Mar 15]. [Figure], Global distribution of the number of children who did not receive three doses of DTP-containing vaccine during 2013 (millions). Available from: http://data.unicef.org/child-health/immunization#figimage_59