Transcript Vaccination

Vaccination
An Underappreciated Component
of the Modern Medical
Armamentoarium
Vocabulary
• Vaccine:
– A preparation that contains microorganisms or
their parts to which immune systems
responds to.
• Toxoid:
– An inactive toxin that is no longer harmful but
retains its unique Ag determinants.
Types of Vaccines
• 2 Types of vaccines
– Whole-agent
• Attenuated (Weakened)
• Inactivated (killed)
– Subunit (some part of agent)
Attenuated
• Contain live viruses
• Attenuated tend to mimic an actual infection and
usually provide better and longer lasting
immunity.
• Replicates in the body, increasing the original
dose over time  provides herd immunity
• Life long Without boosters
• Examples measles, rubella, mumps, oral polio
Attenuated Vaccines Cont.
• Attenuated viruses are usually derived
from mutations accumulated during long
term cell cultures.
• Danger of such vaccine is that they can
back mutate to a virulent form, although
this very rarely happens.
Innactivated Vaccines
Whole Organisms that have been killed
– Usually killed by formulin
– Never killed by heat. Why?
– Boosters: Because immunity is not always
long lasting boosters are needed to maintain
immunity.
– Examples; rabbies, influenza vaccines
Subunit vaccines
• Vaccines in which antigenic fragments of
microrganisms that are best suited to stimulate
immune resp.
• Recombiant vaccines
– example Hepatitis B virus
– Portion of the viral protein coat.
– (Less effective) - safer  Cannot reproduce in host 
contain little or no extraneous material thus
– less side effects
DTaP
• D (dephtheria toxoid) T (tetnus toxoid)
aP (acellular pertussis toxoid and surface
adhesin)
– subunit vaccine that is very safe
– Soluble, elicit a humoral response
• Old pertussis vaccine was made from
inactivaed whole unit bacteria (Bordetella
pertussis)
Immunizations
• Idaho is ranked 50th in immunization for
children 19-35 months of age.
– 4:3:1
– 4 doses of DTP
– 3 doses of oral polio
– 1 dose of measles vacine
Is the MMR Vaccine Safe?
• Researchers in the UK studied the records of 498
children with autism born between 1979 and 1998. They
found:
• The percentage of children with autism who received
MMR vaccine was the same as the percentage of
unaffected children in the region who received MMR
vaccine.
• There was no difference in the age of diagnosis of
autism in vaccinated and unvaccinated children.
• The onset of "regressive" symptoms of autism did not
occur within 2, 4, or 6 months of receiving the MMR
vaccine.
A Larger Study in Japan
• The Japanese MMR vaccination program
targeted one-year-olds between April 1989 and
April 1993, then was discontinued.
• Therefore, children born during the years 1988
to 1992 received the MMR vaccine.
• According to Yokohama statistics, MMR
vaccination rates declined from 69.8% in the
1988 birth cohort, to 42.9%, 33.6%, 24.0%, and
a mere 1.8% in birth cohorts 1989 to 1992.
• What was the effect on Autism?
No effect of MMR withdrawal on the incidence of autism: a total
population study
Cohort total = 31,426 individuals
69.8%
received
MMR
42.9%
33.6% 24.0%
Journal of Child Psychology and Psychiatry 46 (6), 572–579.
1.8%
0.0%
received
MMR
An association is not the same
as “cause and effect.”
Other environmental factors have been
associated with autism.
“Involunteer experiment”
• 1980-sensationalized and highly inaccurate
news accounts of alleged side effects of
pertussus caused many parents in the United
Kingdom to refuse the pertusus toxoid in DTP.
• An epidemic of whooping cough occurred in the
United Kingdom, in which 100,000 children were
infected and 36 died. Many of the survivors
sustained brain damage.
Most parents today have never seen a case of diphtheria, measles, or other
once-common diseases now preventable by vaccines.
As a result, some parents wonder why their children must receive shots for
diseases that do not seem to exist.
Annual morbidity before the vaccine became
available compared to morbidity in 1998
Disease
Smallpox
Diphtheria
Pertussis
Tetanus
Polio
Measles
Mumps
Rubella
Annual
morbidity
48,164
175,885
147,271
1,314
16.317
503,282
152,209
823
1998
morbidity
0
1
6,279
34
0
89
606
5
% Decrease
100
100
95.7
97.4
100
100
99.6
99.4
Why aren’t there more Vaccines?
• Many of the barriers to vaccine development are
financial, legal, and political rather than
scientific.
• Vaccines are not nearly as profitable as mind
altering drugs or heart medications.
• The development of vaccines have focused on
diseases that are widespread and usually not
serious.
• Numerous lawsuits based on alleged, rare side
effects of vaccines.
Comparison of global military spending and
spending on prevention of infectious diseases.
Spending
Deaths
Link
Vaccines-a Health Care Bargain
• A good vaccine can provide lifelong
immunity to an infectious disease.
• Vaccines are much cheaper than
diagnosis and treatment of infections after
they have started
• They prevent human suffering and may be
the only form of treatment known for some
ailments.
Vacinations
• Vaccines currently under development
– Contraception
– Cancer
– cocaine addiction
• There is no absolute limit to the number of
vaccines that can be safely given to a person.
– All standard vaccines recommended for children can
be given to the same person, at separate anatomical
sites, on the same day
– It is safe to give mildly sick children vaccinations
Vaccine Against Cancer
• If there was a vaccine on the market which
protected you from cancer would you take
it?
Gardasil
• A new recombinant vaccine that protects women from
cervical cancer.
• Cervical cancer is the second leading cause of cancer
death among women in the world, killing more than
250,000 a year.
• The vast majority of cervical cancer is caused by the
Human Papilloma Virus (HPV).
– This is a very common virus. By the age of 50, about 80% of all
women have been infected by it at one point or another.
– HPV is sexually transmitted
• Is Gardasil safe?
– Test conducted on over 11,000 people
showed only minor problems. Some people
had a slight fever. Others complained of
redness or irritation on the skin at the site of
the injection.
• Is Gardasil effective?
– The vaccine is between 95-100% effective
against HPV types 6, 11, 16, 18 if taken prior
to infection.
• How is Gardasil made?
– Gardasil is a non infectious recombinant
vaccine made from highly purified virus like
particles of the major capsid protein L1.
• Should Gardasil be made mandatory?
Manditory Vs. Morals
• The catch with this vaccine has nothing to
do with its effectiveness or its safety.
• The catch is that Human Papilloma virus is
sexually transmitted.
• Cure For Cancer
Cancer in Utah Mormon women by
church activity level.
Gardner JW, Lyon JL
In light of low cancer rates by the Mormon Church, this study classifies
female Mormon cancer patients in Utah according to measures of
adherence to Church doctrines. The distribution by Church activity level
is compared for each site to a group of other cancer sites felt to
represent the overall activity level distribution of Utah Mormon women.
Mormon women classified as having the strongest adherence to Church
doctrines had lung cancer rates during 1966-1970 much lower than did
women with the weakest adherence. The relationship was not as strong,
however, as that seen in Mormon men when classified by lay priesthood
office. Cancer of the uterine cervix also showed lower rates in the more
active groups, but this finding was not statistically significant. Cancers of
the breast and ovary did not show consistent associations with Church
activity level, nor did most of the gastrointestinal cancers. These data
suggest that some of the differences in cancer incidence between
Mormons and non-Mormons may not be explained by adherence to
specific Church doctrines.
Am J Epidemiol. 1982 Aug;116(2):258-65.
Health Care and African
Americans
• As a group, many older African Americans
are skeptical of govt. run health programs
and immunizations.
• Much of the skepticism stems from a govt.
run study conducted in Tuskegee Alabama
from 1932 to 1972.
Tuskegee Syphilis Study
• was a clinical study
conducted between 1932
and 1972 in Tuskegee,
Alabama, in which 399
poor — and mostly
illiterate — African
American sharecroppers
were studied to observe
the natural progression of
the disease if left
untreated.
• the Tuskegee scientists withheld penicillin and information about
penicillin, purely to continue to study how the disease spreads and kills.
Participants were also prevented from accessing syphilis treatment
programs that were available to other people in the area. The study
continued until 1972, when a leak to the press resulted in its termination.
•
Listen to Alex Chadwick's report.