History of Vaccines Blog
January is National Cervical Health Awarenss Month. My friend Izumi Kajimoto writes today's post. I am writing this on my mother’s 77th birthday – a mark she missed by thirty years. “Preventable cancer” is something you don’t want to hear to describe what killed your mother young. I didn’t waste time bitter that tests were available, but under-publicized, to have caught it in time for her. But I figured I owed it to knowledge and sense to get my first colonoscopy at age 25 (an uncle died of it too: I have it on both sides) and every five years since. Nothing is more exhilarating than having a hose crawling up your butt for an hour – then being told you don’t have cancer. I am one of the few lucky ones who had to quit smoking only once, and it was easy. Keeping the weight down, running a lot, I thought I was doing my bit to prove the preventability of something that wiped out a chunk of my family.
December 20, 2013
Our advisor, Thomas Fekete, MD, FCPP, wrote today’s post. Dr. Fekete, a frequent contributor to this site and an active Fellow here at the College, has many responsibilities at Temple University Hospital and School of Medicine: Section Chief, Infectious Diseases; Professor, Medicine; Associate Professor, Microbiology and Immunology; and Executive Vice Chair for Clinical Affairs, Department of Medicine. Twenty-plus years ago, an improved (protein-conjugated) vaccine for Haemophilus influenzae type b (Hib) was approved and deployed extensively in young children in most developed countries. There was a rapid and sustained drop in serious infections caused by Hib. This reduction of meningitis, pneumonia, blood infections, and so on was dramatic and was accompanied by a major reduction in the formerly common and seemingly innocent carriage of Hib in the throats of children. As a result, even unvaccinated children had protection from Hib via herd immunity.
December 19, 2013
In Mali, the mortality rate for children under five is about 20%, higher than the overall child mortality rate in the World Health Organization Africa Region. It performs worse than much of the region in per capita GDP, government expenditure on health care, maternal mortality rate, and many other measures. Here at the College this week, representatives from Mali Health Organizing Project paid a visit to tell us about their work. Mali Health is a nonprofit group working to reduce child mortality and improve maternal and child health in under-resourced communities in Mali’s capital, Bamako. Since 2006, it has trained and deployed community health workers to work in Bamako’s slums, where they make home visits to evaluate child health, and help facilitate access to healthcare for children and pregnant women.
December 9, 2013
For National Influenza Vaccination Week, I had the pleasure of interviewing Dalton 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). NIVW is a national observance that was established to highlight the importance of continuing influenza vaccination, as well as fostering greater use of flu vaccine after the holiday season into January and beyond. Dr. Paxman is a Fellow here at The College of Physicians of Philadelphia. His biographical information is below. Many thanks to Dr. Paxman and to Mahak Nayyar, MPA, FCPP, Deputy Regional Health Administrator, for her coordination.
October 16, 2013
John A. Kolmer, MD (1886-1962), was a Philadelphia physician whose interests included infectious diseases and public health. He developed a test for syphilis – the Kolmer test – and he was involved in early tests of Salvarsan, the first effective treatment for the disease. He is also known for his disastrous 1934 trial of a live polio vaccine that caused deaths and paralysis in some recipients. After the vaccine trial, Kolmer abandoned polio studies and focused on teaching public health and preventive medicine at Temple Medical School. In his book about the 1955 Cutter incident, Paul A. Offit, MD, mentions that Kolmer had been called in to treat President Calvin Coolidge’s son Cal, when the boy became ill in 1926.
October 7, 2013
Elena Conis published a recent essay in the Bulletin of the History of Medicine, entitled “A Mother’s Responsibility: Women, Medicine, and the Rise of Contemporary Vaccine Skepticism in the United States.” I had heard Conis give a talk on this same topic at a conference a few years earlier, and some her claims didn’t sit well with me. In the BHM piece, she looks at vaccine resistance beginning in the 1970s and 1980s and traces its origins to second-wave feminism and its critical view of the medical establishment. Her argument is that at a time when women were still being asked to be guardians of their children’s health – uniquely in a position to protect and care for their children in what was still an almost Victorian model of motherhood – feminist notions of self-care and self-empowerment conflicted with medical practice around vaccination. Parents, particularly mothers, began to question received medical notions about vaccination – that benefits of disease prevention almost always outweighed the risks of vaccination. In publications as extremely back-to-nature as Mothering and as conventional as Dear Abby columns, women discussed the need for vaccination and worried about medical side effects
October 3, 2013
Today’s blog post is by History of Vaccines advisor Thomas Fekete, MD, FCPP. Dr. Fekete is infectious diseases section chief at Temple University School of Medicine. This piece follows my post from Tuesday, which looks at mandatory influenza vaccination policies and implementation at Childrens Hospital of Philadelphia and other area health systems. In the community, influenza can be transmitted at home, at school, at work or in other public venues. During the influenza pandemic of 1918-1919, large public events in cities like Philadelphia were followed by enormous waves of influenza illness and death.
October 1, 2013
As influenza season approaches, many hospitals and health systems are asking their staff to take the influenza vaccine. Some merely suggest or recommend it, but others mandate it. Consequences for noncompliance range from having to wear a mask during patient care encounters during the influenza season to termination of employment. The reasoning behind requiring health care worker (HCW) influenza immunization relates to possible effects on outcomes related to the hospital environment and patient care, such as preventing spread of influenza to patients, worker absenteeism during busy influenza season, and modeling preventive health behaviors to patients.
September 30, 2013
On Friday, September 27, Johns Hopkins Bloomberg School of Public Health held its annual Vaccine Day. Bruce Aylward, MD, MPH, Assistant Director-General, Polio, Emergencies and Country Collaboration, World Health Organization, gave the keynote address. His title was "Eradicating Polio: Is the Juice Worth the Squeeze?" Aylward’s riveting Ted Talk explores similar topics, and so I won’t summarize much of what he discussed. But his picture of the economic benefits of polio eradication was quite interesting. Aylward noted that “It’s not enough that the cost benefit ratio is positive. It has to be very much in favor of the benefits, because the risks to failure are high.” Smallpox eradication provides a model for estimating the cost/benefit ratio of eradication. Aylward noted that the US saved about 159 dollars for every 1 dollar spent on eradication. For the international campaign, the ratio is about 400:1. And the United States recoups its financial investment in the smallpox eradication campaign every 26 days. So, he asserts, smallpox eradication was unequivocally worth the “squeeze.”
September 16, 2013
As I was reading Charles Dickens’s Bleak House, I was interested to find a description of an illness that most likely was smallpox. The incident involves Esther Summerson, the self-sacrificing heroine. At one point in the book, she performs the kind of act of charity we so often read about in novels from the era – a kind woman ministering to the poor and ill. She walks into a house to which her maid has brought her and notices an unpleasant fact. “The place … had an unhealthy and a very peculiar smell.” Many reminiscences of smallpox mention the characteristic smell of the disease. In “The Demon in the Freezer,” Richard Preston quotes D.A. Henderson, director of the WHO’s Smallpox Eradication Programme: “My God, they talk about the odor of smallpox. It is an odd smell, not like anything else…It's a sickly odor, like rotting flesh, but it's not decay, because the skin remains sealed and the pus isn't leaking out….That smell is one of the mysteries of smallpox. No one knows what it is. " A boy in the house is feverish, and Esther and the maid tend to him.