History of Vaccines Blog
We've all been following the National Hockey League mumps outbreak in the past few weeks. And by now, those of us who are known for opining on infectious diseases have been asked by our friends why even people who are fully and recently vaccinated are coming down with the disease. (Here's the short version: Two doses of mumps vaccine are 88% (range: 66-95%) effective at preventing disease, so in an outbreak, a certain percentage of fully (2 doses) and partially (1 dose) immunized individuals are vulnerable to becoming ill, as are all the unvaccinated people exposed. For more information see Mumps Vaccine Effectiveness in Highly Immunized Populations and Mumps Outbreaks in Vaccinated Populations: Are Available Mumps Vaccines Effective Enough to Prevent Outbreaks?)
December 11, 2014
For National Influenza Vaccination Week, I had the pleasure of interviewing Dalton G. Paxman, PhD, FCPP, Regional Health Administrator for the mid-Atlantic region, where he oversees public health initiatives for the Office of the Assistant Secretary for Health (OASH), U.S. Department of Health and Human Services (HHS). Dr. Paxman is a Fellow here at The College of Physicians of Philadelphia. Influenza season has begun – has there been much influenza nationally yet? What kind of activity are we seeing in HHS Region 3? Flu activity is beginning to increase in parts of the United States and CDC is getting reports of flu illnesses, flu hospitalizations, and flu deaths. Influenza A (H3N2) viruses are most common so far. H3N2 predominant seasons are associated with more severe illness and mortality, especially in older people and young children, than during H1N1- or B-predominant seasons. If H3N2 viruses continue to predominate, this season could be severe.
December 10, 2014
It's National Influenza Immunization Week, an observance sponsored every year by the CDC to highlight the national immunization influenza vaccination recommendations. For the past several years, all US individuals in the United States over 6 months of age have been recommended by the Advisory Committee on Immunization Practices to get the influenza vaccine. This influenza season has already been eventful, not only in terms of morbidity and mortality, with five pediatric deaths reported, but also in terms of questions about influenza vaccination effectiveness. First, earlier this fall CDC announced a puzzling finding: in certain groups of children during the 2013-14 flu season, the live attenuated influenza vaccine was less effective against the circulating H1N1 virus than the inactivated vaccine. This finding was unexpected because the live vaccine has in other seasons provided superior protection than the inactivated vaccine.
December 2, 2014
You’ve read the headlines, now you can learn the facts. Ebola: Let's Talk About This Virus is an opportunity for medical and non-medical audiences to learn more about Ebola virus and Ebola virus disease from specialists. Speakers will address questions such as, What are viral hemorrhagic fevers and why are they unique? How can Ebola virus disease be prevented, controlled, and treated? What is the impact of geographic location on disease transmission? What does the future hold in terms of treatment options?
October 27, 2014
Here at The College of Physicians of Philadelphia we have about 44 full- and part-time staff people. When a cold or the flu is going around, 10% to 20% of staff can be at home sick. That makes staffing a challenge, particularly because we have to have enough personnel here to sell tickets to the Mütter Museum and staff the museum store. In winter 2013, I polled the employees here and found that only 43% had gotten the flu vaccine in the 2012-13 season. To try to boost our uptake of the vaccine, in fall 2013 I organized a flu vaccine awareness campaign. The result was that about 70% of staffers got the vaccine for the 2013-14 season. This year we decided to reduce all the barriers to vaccination (the trip to the doctor or the pharmacy, needing one's insurance card, inertia), and we brought a pharmacist here to give the trivalent inactivated influenza vaccine to any staffers or contractors who wanted it. As an incentive, and like last year, we gave a $10 Trader Joe's gift card to anyone who got the vaccine.
October 20, 2014
A few weeks ago, I attended a talk by the CDC's Anne Schuchat, MD, on US HPV vaccination that she subtitled “How Not to Introduce a Vaccine.” In spite of the promise of HPV vaccines to reduce the burden of cervical and other cancers in this country, uptake of the complete three-dose series has lagged far behind the other vaccines on the adolescent immunization platform. On Friday, I heard a more optimistic talk about HPV vaccination in African countries by Helen Rees, MD, MA, Executive Director, Wits Reproductive Health and HIV Initiative, University of Witswatersrand. Dr. Rees is a member of the WHO immunization policy committee and has a background in pediatrics, HIV care, and obstetrics and gynecology. She spoke as a guest of the Johns Hopkins Vaccine Initiative as part of their annual Vaccine Day events. Globally, 90% of HPV-related cancers are cervical cancers, and sub-Saharan Africa is, as Rees said, the epicenter for cervical cancer. The high prevalence of HIV infection, which is a risk factor for oncogenic HPV infection, and the lack of access to HPV screening contribute to the high HPV disease burden. And apart from HPV-related cancers, Rees also noted that genital warts are not a trivial condition in an HIV-prevalent setting: they can be debilitating in those with compromised immune systems. The quadrivalent HPV vaccine offers protection from the two most common types of oncogenic HPVs and two types that cause genital warts; the bivalent vaccine covers only the two most common types of oncogenic HPVs.
How is the immune system similar to your marathon time? As we age, our immune response decreases at the same slope that our marathon race times increase. Presenters laid out this and some of the other problems of immunizing adults in the Symposium on Adult Immunizations, an early session at the Infectious Diseases Society 2014 conference at the Philadelphia Convention Center. Kenneth Schmader, MD, noted that though adults age differently – some adults at age 75 may be running marathons while others may be frail – all are subject to immune system senescence, and all are vulnerable to rapid functional declines that may result from an acute stressor, whether it’s a fall or a debilitating case pneumococcal pneumonia.
September 24, 2014
On Monday, September 22, in Philadelphia, Matthias J. Schnell, PhD, of the Jefferson Vaccine Center, announced that one of his lab's Ebola virus vaccine candidates was moving into human trials. Funding from the National Institute of Allergy and Infectious Diseases and the Department of Defense will allow production of a clinical lot of the vaccine for a Phase 1 trial that could be completed as early as mid-2015 (see Anthony Fauci's testimony to the House Foreign Affairs Committee). Schnell addressed a gathering of diplomats, scientists, and large audience of students and healthcare professionals at Thomas Jefferson University to discuss the Ebola epidemic in West Africa. Ambassadors of Sierra Leone, Ivory Coast, and Guinea spoke about the difficulties of epidemic response in their countries, which are especially complex given the legacies of years of civil unrest there.
September 18, 2014
The news of infant deaths on September 16 in northern Syria from measles vaccination is heartbreaking. Shortly after vaccination, the children became limp and unresponsive: those most severely affected died before reaching hospital. Seventy-five children were affected, and fifteen died. The World Health Organization is investigating the incident. The first reports couldn't identify the problem and speculated that the vaccine had spoiled or that it had been tampered with. The latest reports state that atracurium, a neuromuscular blocking agent used in procedures like intubation, was used as a diluent for measles vaccine, rather than the standard water-based diluent.
September 10, 2014
Tonight be sure to watch or record "Vaccines: Calling the Shots," the latest installment of NOVA on PBS. This documentary looks at parental attitudes toward vaccination and their influences on disease spread. Check your local listings -- here in the Philadelphia area it's scheduled for 10 pm, but in other areas it's scheduled at 9 pm Eastern. Additionally, there's the matter of the President's televised address at 9 pm Eastern, which is likely to push the broadcast later. We here at The College of Physicians of Philadelphia were lucky enough to host award-winning filmmaker Sonya Pemberton (who wrote/produced/directed the film)--and her crew in 2012, when they were filming segments of the documentary. A version aired in 2013 as 90-minute film titled "Jabbed: Love, Fear, and Vaccines."