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IMMUNIZATIONS IN 2014 . Head to toe conference may 2014. Lance Chilton, M.D. Professor, Pediatrics University of New Mexico. The reason we immunize. Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- United States, 1990-1998

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Immunizations in 2014

IMMUNIZATIONS IN 2014

Head to toe conference may 2014

Lance Chilton, M.D.

Professor, Pediatrics

University of New Mexico


The reason we immunize
The reason we immunize

Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- United States, 1990-1998

At the beginning of the 20th century, infectious diseases were widely prevalent in the United States and exacted an enormous toll on the population. For example, in 1900, 21,064 smallpox cases were reported, and 894 patients died (1). In 1920, 469,924 measles cases were reported, and 7575 patients died; 147,991 diphtheria cases were reported, and 13,170 patients died. In 1922, 107,473 pertussis cases were reported, and 5099 patients died (2,3).

Dramatic declines in morbidity have been reported for the nine vaccine-preventable diseases for which vaccination was universally recommended for use in children before 1990 (excluding hepatitis B, rotavirus, and varicella) . Morbidity associated with smallpox and polio caused by wild-type viruses has declined 100% and nearly 100% for each of the other seven diseases.

MMWR, April 2, 1999



A influenza aka just the flu
A: influenza disease?AKA: “Just the flu”

Molinari et al. Vaccine 25 (2007) 5086–5096



New mexico s school kids influenza immunization project
New disease?mexico’s school kids’ influenza immunization project

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Kudos to skiip and to all of you
Kudos to disease?skiipand to all of you!


Early albuquerque data flu school absences
Early Albuquerque data: Flu disease? school absences

Gurule, Escareno, Dharas, Pentler, Skipper and Chilton, unpublished



Where do immunization recs come from
Where do immunization recs come from? disease?

  • American Academy of Pediatrics Committee on Infectious Diseases (Red Book Committee) : meets twice a year, produces Red Book every 3 years

  • ACIP – Next Meeting: June 25-26, 2014, Atlanta

    • Informational items

    • Votes



Screen for Powerpoints disease?

Podium

Larry Pickering

Jonathan Tempte

Head Table

Audience

Audience

L

L

M

M

ACIP

Members

Liaisons

Audience


ACIP Products disease?

www.cdc.gov/vaccines



Are vaccines safe and what s vaers anyway
Are vaccines safe? disease?AND WHAT’S VAERS ANYWAY?

Vaccine Adverse Effects Reporting System


VSD disease?


The v accine s afety d atalink
The disease?vaccine safety datalink

This is the most robust vaccine safety system; there are others (example: military).


The rotashield story born 1998 died 1999
The disease?rotashield® story (born 1998, died 1999)

  • Rotavirus kills some 450,000 children per year around the world; 20-60 in the United States

  • Early 1990s , clinical trials showed 80-100% effectiveness against severe rotavirus diarrhea and excellent safety profile

  • 1998: RotaShield licensed

  • Late 1998: reports to VAERS of many cases of intussusception after RotaShield receipt

  • VAERS Signal reported to VSD, which affirmed the hypothesis that RotaShield associated with intussusception

  • 1999: Rotashield removed from market.

  • Early 2000s, clinical trials on far more children showed no association with intussusception for two new vaccines, Rotarix® and Rotateq®

  • 2006: Rotarix and Rotateq approved by FDA and recommended by ACIP

SUCCESS

OR FAILURE OF THE VACCINE SAFETY SYSTEM?



Penn and teller s approach to vaccine safety discussion
Penn and teller’s approach disease?to vaccine safety discussion

Viewer Discretion Advised


Paul offitt s approach
Paul disease?offitt’sapproach


Dr bob sears approach
Dr. bob sears’ disease?approach



Too many antigens
Too many antigens? disease?

  • 2012: 2 month shots:

  • Antigens:

  • Rotavirus 5

  • Pediarix

    • Diphtheria 1

    • Tetanus 1

    • Pertussis 3

    • Polio 3

    • Hepatitis B 1

  • H. Influenzae B 1

  • Pneumococcal 13

  • Total 28

Streptococcal Infection =

25-50 antigens

Upper respiratory

infection =

4-10 antigens

In the old days:

Smallpox vaccine =

~200 antigens

Whole cell pertussis vaccine =

~3000 antigens


Declining number of antigens
Declining disease? number of antigens:


Vaccines aren t free
Vaccines aren’t free disease?

  • But no, folks, you won’t have to pay for vaccines in New Mexico (yet).


In 42 states
In 42 states… disease?

  • But only for

  • Uninsured

  • Native Americans/Alaska Natives

  • Medicaid insured

  • Underinsured

    • But only in FQHC or RHC


In 6 states nh ri vt wi wy and
In 6 states (NH, RI, VT, WI, WY and… disease?

New mexico!)

  • For all children and adolescents before their 19th birthday

Alaska, Hawaii, Maine, Massachusetts, South Dakota, Washington cover most but not all childhood vaccines


Are these vaccines affordable
Are these vaccines affordable? disease?

  • In Arizona, Colorado, Utah, Texas and most other states, the total private sector price of all vaccines for each person (except influenza) through age 18 was $2171 + vaccine administration as of April 2014.

  • In New Mexico, the price to patients is $0 + vaccine administration

Vaccines for Children for everyone in New Mexico is under attack!


Why is this important
Why is this important? disease?

Vaccines for the first five years

Vaccines for adolescence

April 1, 2014, CDC data


Is it worth it figures for one birth cohort 2009 4 26 million births
Is it worth it? FIGURES FOR ONE BIRTH COHORT – 2009: 4.26 MILLION BIRTHS

Cost:benefit ratio

Direct costs only: 3.0

Total societal costs: 10.1

THAT’S $20 BILLION and $76 BILLION!

DEATHS

Zhou F et al. Economic Evaluation of the Routine Childhood Immunization Program in the US, 2009. Pediatrics, 2014. 133:577.


Results
RESULTs… MILLION BIRTHS

VACCINE

for everyone else

VFC

VACCINE

$90,000



This is why we do it
This is why we do it… MILLION BIRTHS


My patient post hib meningitis
My patient, post MILLION BIRTHShib meningitis

Age 34


How re we doing on individual adolescent vaccines
How’re we doing on MILLION BIRTHSindividual adolescent vaccines?

90

80

70

60

50

40

30

20

10

HOW DO THEY DO THAT?

UK

Vaccines for Children for everyone in New Mexico is under attack!

?

CDC 2012 NIS data in MMWR, Aug. 30, 2013


Cervical cancer in new mexico
Cervical cancer in new MILLION BIRTHSmexico

New Mexico Tumor Registry, 2006-2010 data


Prevalence of individual human papillomavirus (HPV) types among females aged 14–19 years, 2003–2006 and 2007–2010.

Markowitz L E et al. J Infect Dis. 2013;208:385-393

Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013.


Special communiqu from the front
Special communiqué from the front among females aged 14–19 years, 2003–2006 and 2007–2010.

HPV vaccination does not cause teenagers to have sex

Mayhew A et al. Sexual Behaviors after HPV Vaccination. Pediatrics, 2014. 133:404.


Should we give more vaccines in new mexico schools
SHOULD WE GIVE MORE VACCINES IN among females aged 14–19 years, 2003–2006 and 2007–2010. NEW MEXICO SCHOOLS?

  • No

  • School nurses already have too many tasks

  • Some vaccines are too controversial

  • Yes

  • That’s where the kids are!

  • We could teach about the diseases prevented


Thank you for all you do
Thank you for all you do! among females aged 14–19 years, 2003–2006 and 2007–2010.

  • "Schools have a wealth of potential for ensuring the future well-being of young people. You can't educate a child who isn't healthy, and you can't keep a child healthy who isn't educated."

  • -- M. Jocelyn Elders, MD


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