A Tale of Three Vaccines

I write on a somewhat regular basis on here about vaccines: new research, new shots, addressing skepticism about how well they work or if they’re related to autism, etc. Recently, several vaccine stories have been in the news that I’ve not gotten to yet, so consider this a vaccine meta-post. More after the jump.

The first story is timely in that it discusses the influenza vaccination (and we’re heading into that season). Allow me to share an anecdote first. When I was pregnant with my daughter in 1999, I was in graduate school and the lab I worked in was affiliated with a hospital. So, of course they offered flu shots, particularly for those in high-risk groups (and pregnant women are one of those groups). When I went to get my vaccine, however, the nurse refused to give it to me, saying they were not allowed to vaccinate pregnant women due to “the risks.” I had to return later with the CDC’s recommendation guidelines to prove to her that I should get the vaccine. I wonder how many people–even health care workers–are similarly misinformed. The article suggests that there’s a lot of misunderstanding regarding pregnant women and the influenza vaccine:

The Centers for Disease Control and Prevention says pregnant women are at risk for serious medical complications from flu related to decreased lung capacity, increased heart rate and other conditions of pregnancy. But the message is not being heeded, says Gregory Poland, professor of medicine at the Mayo Clinic in Rochester, Minn.

“Among the groups for whom influenza vaccine is recommended, the lowest group (who receive it) is pregnant women, at 12.9%,” says Poland, who wasn’t involved in the study.

This is even more important now than we knew previously, because the study that’s mentioned found that pregnant women who get the influenza vaccine not only protect themselves, but also their newborn:

Babies born to mothers who received a flu shot during the last three months of pregnancy appear to be protected from infection during their first six months of life, a study suggested Wednesday.

The results of the study, presented at the Interscience Conference on Anti-microbial Agents and Chemotherapy, bolster recommendations for pregnant women to be immunized against flu, says researcher Mark Steinhoff of Johns Hopkins University in Baltimore.

Steinhoff says the results came as part of a study of a pneumococcal vaccine that involved 340 women in Bangladesh in their third trimester of pregnancy. Half of the women got the pneumococcal vaccine, and the other half got flu vaccine, which was used as a control.

Current vaccines are not licensed for babies under 6 months. The study suggests that immunizing pregnant women can protect babies during those months.

Another common problem for babies and toddlers are ear infections. The pneumococcal vaccine mentioned helps to protect against some of these (caused by Streptococcus pneumoniae), but they are still a huge pain for parents (and, of course, children). This vaccine has also reduced serious infections caused by this bacterium, including meningitis. Likewise, the vaccine against serotype B Haemophilus influenzae has reduced invasive infections due to that strain of bacterium since its introduction. However, non-typeable strains of H. influenzae still circulate, and while they rarely cause serious invasive disease, they’re a major cause of ear infections, sinus infections, and bronchitis. A new vaccine aims to reduce these as well:

U.S. researchers said on Tuesday they are starting trials of a new vaccine aimed at wiping out childhood ear and sinus infections and many cases of bronchitis in adults.

The vaccine will target Nontypeable Haemophilus influenzae or NTHi, which is the main remaining cause of ear and sinus infections and bronchitis, now that vaccines exist for various forms of streptococcal bacteria and Haemophilus influenzae B, the previous leading causes.

While ear infections are never fatal, they can cause serious damage in some children, Pichichero noted. He said 83 percent of U.S. children experience one or more ear infections by age 3 and in some cases hearing loss becomes permanent.

And the infections force children to visit clinics and emergency rooms, and are the leading reason for antibiotic prescriptions. Experts agree antibiotics are overused in the United States, which wastes money and also helps “superbug” bacteria evolve that resist the drugs.

But finally, not all vaccination news is good news. While there is residual anti-vaccine sentiment in the United States for a variety of reasons and across the political spectrum, it’s even worse elsewhere:

Polio’s return due to vaccine fears in Nigeria

For Ramatu Garba, the polio vaccine is part of an evil conspiracy hatched in the West to sterilize Nigerian girls.

“Allah used Muslim scientists to expose the Western plot of using polio vaccines to reduce our population,” said the 28-year-old Muslim food vendor in Kano.

Each time health teams have tried to vaccinate her daughter, Garba has refused.

It’s been three years since local politicians began a campaign of fear and rumor, claiming the polio vaccine would sterilize children. Those unfounded fears still persist today, and it’s this myth, and others like it, that are largely responsible for the spread of polio into almost two dozen other countries where it was once stamped out.

“The world is still paying the price for what happened in Nigeria in 2003,” said Dr. David Heymann, the top official for polio eradication with the World Health Organization. Most of the new infections in other countries can be traced to Nigeria.

And for those who doubt how effective these vaccines are, Nigeria unfortunately can be used as a natural experiment documenting just how critical they are:

The number of polio cases in Nigeria continues to rise. There were 355 cases in 2003; so far in 2006, there are more than 800 cases, WHO reports.

Of course, once trust has been lost, it’s difficult to regain, and the US and Nigeria certainly aren’t the only countries dealing this this:

In Pakistan, a recent court petition — citing Nigerian documents that claim the vaccine contains estrogen — asks the government to end the polio eradication program. In the past, polio vaccinators in Quetta have been stoned and chased out by angry locals.

And in Kenya, there have been devil worship allegations: Parents feared that having their children take the oral vaccine would result in their tongues being magically removed.

And it is difficult to quell vaccination rumors once they start. In Nigeria, experts thought the polio vaccine issue was resolved when politicians lifted the vaccine ban in July 2004.

But for Nigerians like Sadiya Musa, the flip-flop causes even more suspicion.

“How can they say the vaccine is bad and then say it is good again?” asked the mother of six, who believes the vaccine causes sterility and HIV/AIDS. “I cannot be deceived.”

How can a public health professional counter an attitude like that?

Comments

  1. #1 SkookumPlanet
    October 3, 2006

    Counter it similar to the way it’s done in politics. There needs to be a worldwide “false gossip surviellance system” that has professional “media teams” on call, with a doctor’s bag of pre-vetted, culturally-aware potential messages and enough petty-cash to hit the ground buying media.

    It’s now a 24/7/360 degree, networked world. The Bush administration recently set up one of these in the middle east, unfortunately their less than truthfull material will also get disseminate along with the truth. The reason it’s physically in the Middle East is they’ve ralized they lose day responding from Washington, and a day behind apparently matters.

    I think the writing is one the wall. Any sort of group with the bucks/leverage can now buy reality, the one human’s perceive, and mold it to the group’s needs. “Public education” [yuk!] campaigns are easily countered by this approach. The Nigerian BS, and similar, have to be stopped at the source. Otherwise you end up with something that’s metastisized. A more difficult and expensive problem, as obvious in the topic here.

    I think you guys already have a model for this. Also, there’s a concept I know nothing about called “information contagion.”

  2. #2 Alon Levy
    October 3, 2006

    Somewhat off-topic, how important is genetics to vaccine development? In particular, I suppose gene therapy is going to make knowing whether someone’s genetically immune to a disease important, but how important is it now?

  3. #3 knight in dragonland
    October 4, 2006

    The Hib vaccine and to a slightly lesser extent the pneumococcal vaccine have been truly transformative in the practice of pediatrics. They have caused us as pediatricians to rethink how we approach fever without an apparent source in children under 3 years old. Thanks to these vaccines, the cause is much less likely to be a serious bacterial infection.

    I recently completed my residency training in pediatrics at a tertiary referral center. During my 3 year residency career, thanks in large part to these vaccines, I only saw 5 cases of bacterial meningitis – 3 due to Strep pneumoniae (none of the children had received pneumococcal vaccine), one due to Citrobacter freundii (extremely nasty – spinal fluid was literally green and the brain looked like swiss cheese) and one due to Staph aureus (also nasty and not a usual suspect). I didn’t see or even hear about a single case of Hib meningitis in our facility. We also only had one case of epiglottitis (another potentially catastrophic infection related to Hib) during my training. I don’t count the cases of VP shunt infections that I saw (probably another half dozen, usually coag negative staph organisms or Staph aureus) since there’s the obvious additional risk factor of an indwelling foreign body.

    There are two vaccines that I would truly love to see and that would be transformative for my practice – (1) Staph aureus and (2) respiratory syncytial virus.

    I’ve also always wondered – why does RSV get such little play in the media? It fills the wards of pediatric hospitals during a bad season, yet the mainstream media ignores it for the most part.

  4. #4 montrachet
    October 4, 2006

    I’m not surprised a nurse didn’t want to give you a flu shot. Their unions are staunchly opposed to work rules or statutes requiring health care workers to have flu shots, because nurses have all the same misconceptions about flu vaccine that the general public has.

    We tend to think of nurses as “almost-docs,” but it seems like staffing shortages have lowered the bar with respect to admission to nursing school, and economic pressures have pushed more of the lower-level degrees into patient care (CNAs doing what RNs used to do).

  5. #5 Urinated State of America
    October 5, 2006

    On the Nigerian vaccine rumors,

    Didn’t the apartheid government in South Africa try to develop a “vaccine” to reduce fertility? That might be the root of this urban myth spread by Nigerian clergy/politicians.

  6. #6 JohnnieCanuck
    October 6, 2006

    Have you come across the varicella article by Scheifele in the current Paediatric Child Health?

    They are trying to combat the attitude in both the public and doctors that chickenpox is harmless. The vaccine has been available since 2000 and free since 2004 in the study area, yet only 2/3 of the eligible children have received it.

    From 2000 to 2005 there have been 7 deaths and 1,900 hospitalisations in Canada that mostly could have been prevented.

    from an article in the 2006/10/04 Vancouver Sun.

  7. #7 Charles Hoy
    October 6, 2006

    Babble babble babble…

    What a cute little reunion! Everbody agrees!

    But what do I read here?
    nurses have all the same misconceptions about flu vaccine that the general public has.

    That’s a lot of people who do not agree. Of course, they’ve not yet lost their common sense and they can still smell the odor of foul vaccination practice.

    Take the flu vaccination. Theoretically, vaccination should be a once in a lifetime thing. That’s at least how it started. But now we’re already up to the once a year flu shot. Why? I know the answer: microbe mutation and resistance. Ha, ha, ha ! What a crap.

    Vaccination nonsense, you grow it on greed and fear.

    Interested? Google with “Louis Pasteur” and “Antoine Bechamp”

    Here’s a citation from http://www.laleva.org/eng/2004/05/louis_pasteur_vs_antoine_bchamp_and_the_germ_theory_of_disease_causation_1.html

    We do not catch diseases. We build them. We have to eat, drink, think, and feel them into existence. We work hard at developing our diseases. We must work just as hard at restoring health. The presence of germs does not constitute the presence of a disease. Bacteria are scavengers of nature…they reduce dead tissue to its smallest element. Germs or bacteria have no influence, whatsoever, on live cells. Germs or microbes flourish as scavengers at the site of disease. They are just living on the unprocessed metabolic waste and diseased, malnourished, nonresistant tissue in the first place. They are not the cause of the disease, any more than flies and maggots cause garbage. Flies, maggots, and rats do not cause garbage but rather feed on it. Mosquitoes do not cause a pond to become stagnant! You always see firemen at burning buildings, but that doesn’t mean they caused the fire…

  8. #8 Alon Levy
    October 6, 2006

    Interesting analogy… too bad it bears no relation to reality. There’s this thing called causality: you see burning buildings without firefighters in them (for example, before the firefighters arrive), and you see garbage cans without flies; you don’t see infectious disease without microbes.

  9. #9 Charles Hoy
    October 6, 2006

    you don’t see infectious disease without microbes.

    Without microbes, would you still call a disease infectious? The microbes may cause one or more symptoms like odour and pus (without microbes cell debris are processed differently), they don’t cause the disease.

  10. #10 Seth Manapio
    October 6, 2006

    “The microbes may cause one or more symptoms like odour and pus (without microbes cell debris are processed differently)”

    ————–

    But wait… I thought microbes didn’t effect healthy cells… but now they affect how the cells act, therefore affecting them… how can this BE?

    Hoy is rocking my world, seriously… the guy just denies everything! Of course, he conveniently ignores the fact that history makes absolutely NO sense without the germ theory of disease, localization of plague in the modern world, for example, makes no sense without germs. That’s okay, though, to the super geniousity of Hoy! He sees through such flimflammery, and right to the heart of the matter.

    Its also a little hard, without germs, to explain why prarie dogs die of plague, and why infected lab rats die of disease while identically treated uninfected lab rats don’t, but I promise, Hoy will scour the internet until he can answer these questions too! What will the answers be? Are scientists simply lying? Are our own human biases magically transforming the rats? Only time will tell!

  11. #11 Charles Hoy
    October 6, 2006

    But wait… I thought microbes didn’t effect healthy cells… but now they affect how the cells act, therefore affecting them… how can this BE?

    But.. where did I mention that microbes effect healthy cells?

  12. #12 Charles Hoy
    October 6, 2006

    But wait… I thought microbes didn’t effect healthy cells… but now they affect how the cells act, therefore affecting them… how can this BE?

    But.. where did I write that microbes effect healthy cells? Mystery

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