Vaccination in texas
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Vaccination in Texas. Vaccinations -- Guarding all of us…Protecting our Economy. Advances in Public Health in 20 th Century. Modern Water Sanitation Vaccinations Motor Vehicle Safety Tobacco Hazard Awareness Safer Foods Safer Work Environments Family Planning Healthier Moms and Babies.

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Vaccination in Texas

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Vaccination in texas

Vaccination in Texas

Vaccinations -- Guarding all of us…Protecting our Economy


Advances in public health in 20 th century

Advances in Public Health in 20th Century

  • Modern Water Sanitation

  • Vaccinations

  • Motor Vehicle Safety

  • Tobacco Hazard Awareness

  • Safer Foods

  • Safer Work Environments

  • Family Planning

  • Healthier Moms and Babies


How vaccines work

How Vaccines Work

  • Personal Immunity

    • Develop antibodies to a component of the disease

    • Antibodies prevent disease if exposed

  • Herd Immunity

    • Prevents significant transmission of contagious diseases

    • Acts as a firewall

    • Protection extended to unvaccinated individuals (e.g. very young or immunocompromised)

    • Threshold level of vaccine coverage to be effective


  • Vaccination

    Vaccination:

    • A public and private partnership

    • A responsibility over the lifespan

    • One of the most cost effective ways to protect Texans and the Texas economy


    Comparison of cases and deaths for vaccine preventable diseases

    Comparison of Cases and Deaths for Vaccine-Preventable Diseases

    Vaccines Licensed before 1980

    Source: JAMA


    Vaccines licensed 1980 2005

    Comparison of Cases and Deaths for Vaccine-Preventable Diseases

    Vaccines Licensed 1980 – 2005

    Source: JAMA


    Vaccination in texas

    Diphtheria – 21,053 cases & 1,822 deaths annually pre-vaccine. Since 1980, 54 cases have been reported in the US. Worldwide, 7088 cases reported to WHO in 2008.

    Caused by bacterial toxin

    Sore Throat

    Low grade fever

    Cough

    Airway obstruction

    Death


    Measles pre vaccine 530 217 cases 440 annual deaths 200 u s cases in 2011 highest since 1997

    Measles – Pre-vaccine 530,217 cases & 440 annual deaths. 200+ U.S. cases in 2011 highest since 1997.

    Rash

    Runny Nose

    Fever

    Cough

    Exquisitely contagious

    >90% attack rate for susceptible people

    European epidemic


    A communicable disease outbreak has economic costs

    A communicable disease outbreak has economic costs

    • 2008 San Diego Measles Outbreak: On returning from a trip to Switzerland, an intentionally unvaccinated 7-year old unknowingly infected with measles exposed 839 persons to measles.

    • 106 children (13%) lacked proof of measles immunity (Advisory Committee on Immunization Practices standards)

    • 20 were considered to have had minimal exposure.

    • The parents of 44% of the remaining 86 had declined or intentionally delayed vaccination.

    • 84% of the 86 were eligible to receive post-exposure measles vaccination prophylaxis.

    • 13 (41%) accepted the vaccine. The remaining 73 unvaccinated children were placed under 21-day quarantine.

    • With community vaccination rates of >90%, the outbreak began to subside before containment started.


    San diego outbreak c osts

    San Diego – Outbreak Costs

    The state’s public health response prevented transmission beyond the third generation at a cost of $10,376 per case.

    Total outbreak costs were $176,980:

    • Public sector costs - $124,517 (lab, staff, etc.),

    • Direct medical charges for case patients and exposed infants - $16,163 ($14,458 for hospitalization),

    • Quarantined families reported average direct & indirect costs of $775 per child.

      Sugerman DE, Barskey AE, Delea MG, et al. Measles outbreak in a highly vaccinated population, San Diego, 2008: Role of the intentionally undervaccinated. Pediatrics; 2010.


    Mumps pre vaccine 162 344 cases 39 annual deaths more than 6 500 annual cases no recent u s deaths

    Mumps – Pre-vaccine 162,344 cases & 39 annual deaths. More than 6,500 annual cases & no recent U.S. deaths.

    Fever

    Muscle aches

    Fatigue

    Swollen salivary glands

    Orchitis with risk of sterility


    Pertussis whooping cough

    Pertussis (Whooping Cough)

    Stage 1- runny nose, occasional cough, low-grade fever; lasts 1-2 weeks

    Stage 2- Rapid, prolonged fits of coughing leading to vomiting and exhaustion; infants die of respiratory failure, brain damage or pneumonia; lasts 6-10 weeks

    Stage 3- Gradual reduction of cough over 2-3 weeks

    Most contagious during Stage 1


    Preventable hospitalization costs

    Preventable Hospitalization Costs

    Average costs of child hospital stay, pertussis $5,200

    Source: AHRQ

    Average costs of adult hospital stay, bacterial pneumonia $29,295

    Source: DSHS


    Estimated household costs associated with pertussis outbreak in williamson county texas 2009

    Estimated Household Costs Associated with Pertussis Outbreak in Williamson County, Texas, 2009*

    *D. Bastis, Williamson County & Cities Health District and D. Grey, Southwestern University, unpublished, provisional data & results.


    Paralytic polio

    Paralytic Polio

    Most affected people without obvious symptoms

    1% of cases progress to paralysis

    Spread person to person via fecal-oral route

    Nearly eradicated in 1990’s

    Resurgence of disease in Nigeria, Afghanistan, India and Pakistan


    Hib disease

    HiB Disease

    20000 affected children per year pre-vaccine

    Meningitis

    Epiglottitis

    Severe disability

    Virtually eliminated with vaccine


    Invasive hib story

    Invasive HiBStory


    Influenza

    Influenza

    Millions of cases annually

    20000 children hospitalized each year

    50-150 children die each year

    Vaccine very effective but is victim of misinformation and misunderstanding


    Meningococcal disease

    Meningococcal Disease

    Meningitis

    Meningococcemia

    Poorly recognized in early stages

    High fever

    Body aches

    Rash

    Disability and death


    Meningococcal disease story

    Meningococcal Disease Story


    Vaccine economics comparing physician costs to selling ice cream

    Vaccine Economics - Comparing Physician Costs to Selling Ice Cream


    Ice cream and vaccines

    Ice Cream and Vaccines

    • Similarities

    • Acquisition cost is variable

    • Perishable with defined shelf life

    • Maintenance costs

    • Provision costs

    • Liability for loss


    Ice cream and vaccines acquisition cost

    Ice Cream and Vaccines - Acquisition Cost

    • Product Cost Differences

      • Single Source

        • Prevnar 13, Ipol, Gardisil, Flumist

        • Pistachio Almond, Love Potion #31

      • Multiple Source

        • Dtap, Hib, Tdap, Hep B

        • Vanilla, Chocolate, Strawberry


    Ice cream and vaccines1

    Ice Cream and Vaccines

    • Differences

    • Unit cost (financial risk)

    • Sales tax, vs. excise tax + franchise tax

    • Payment terms

    • Ice cream vs. I scream


    Ice cream and vaccines provision costs

    Ice Cream and Vaccines - Provision Costs

    Icecream- Napkins, cups, cones, spoons, tables, chairs, sprinkles, scoops

    Vaccines - Syringes, needles, alcohol pads, bandages, 7 feet of table paper, examination table


    Ice cream and vaccines2

    Ice Cream and Vaccines


    The anti vaccine phenomenon

    The Anti-Vaccine Phenomenon

    • Vaccines become victim of anecdote.

    • Vaccines become victim of success.

    • Science is less convincing than a

      • sincere story.

    • Acts of commission vs. omission.


    The anti vaccine phenomenon1

    The Anti-Vaccine Phenomenon

    If you watch TV you know less about the world than if you just drink gin out of a bottle.

    • Garrison Keillor

    • Jenny McCarthy, Jim Carrey, Oprah, Bill Maher, Larry King

    • Dr. Oz, Dr. Bob


    The anti vaccine phenomenon2

    The Anti-Vaccine Phenomenon

    The trouble with the world is not that people know too little, it’s that they know so many things that just aren’t so.

    • Mark Twain

    • Pockets of vulnerability

    • Return of vaccine-preventable diseases

      • Measles, HiB disease, pertussis


    Why bother

    Why Bother?

    Providing vaccines to a patient is the only medical service provided to an individual that benefits the rest of society


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