Immunizations in 2014
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IMMUNIZATIONS IN 2014 . Head to toe conferencemay 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

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Immunizations in 2014

IMMUNIZATIONS IN 2014

Head to toe conferencemay 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


Q what is still the most common vaccine preventable disease

Q: What is Still The most common vaccine-preventable disease?


A influenza aka just the flu

A: influenzaAKA: “Just the flu”

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


Influenza deaths in children

Influenza deaths in children


New mexico s school kids influenza immunization project

New mexico’s school kids’ influenza immunization project

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Kudos to skiip and to all of you

Kudos to skiipand to all of you!


Early albuquerque data flu school absences

Early Albuquerque data: Flu  school absences

Gurule, Escareno, Dharas, Pentler, Skipper and Chilton, unpublished


Doesn t he ever stop talking about influenza

Doesn’t he ever stop talking about influenza?

He does.


Where do immunization recs come from

Where do immunization recs come from?

  • 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


Red book committee

Red book committee


Immunizations in 2014

Screen for Powerpoints

Podium

Larry Pickering

Jonathan Tempte

Head Table

Audience

Audience

L

L

M

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ACIP

Members

Liaisons

Audience


Immunizations in 2014

ACIP Products

www.cdc.gov/vaccines


A bit about vaccine safety

A bit about vaccine safety


Are vaccines safe and what s vaers anyway

Are vaccines safe?AND WHAT’S VAERS ANYWAY?

Vaccine Adverse Effects Reporting System


Immunizations in 2014

VSD


The v accine s afety d atalink

The vaccine safety datalink

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


The rotashield story born 1998 died 1999

The 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?


How should we communicate how safe vaccines are

HOW SHOULD WE COMMUNICATE HOW SAFE VACCINES ARE?


Penn and teller s approach to vaccine safety discussion

Penn and teller’s approachto vaccine safety discussion

Viewer Discretion Advised


Paul offitt s approach

Paul offitt’sapproach


Dr bob sears approach

Dr. bob sears’approach


Dr sears vaccine schedule

Dr. sears’ vaccine schedule


Too many antigens

Too many antigens?

  • 2012: 2 month shots:

  • Antigens:

  • Rotavirus5

  • Pediarix

    • Diphtheria1

    • Tetanus1

    • Pertussis 3

    • Polio 3

    • Hepatitis B1

  • H. Influenzae B1

  • 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 number of antigens:


Vaccines aren t free

Vaccines aren’t free

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


In 42 states

In 42 states…

  • 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…

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?

  • 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?

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…

VACCINE

for everyone else

VFC

VACCINE

$90,000


That s the business side how about the personal context

That’s the business side; how about the personal context?


This is why we do it

This is why we do it…


My patient post hib meningitis

My patient, post hib meningitis

Age 34


How re we doing on individual adolescent vaccines

How’re we doing on individual adolescent vaccines?

90

80

70

60

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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 mexico

New Mexico Tumor Registry, 2006-2010 data


Immunizations in 2014

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

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 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!

  • "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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