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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

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
  • 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


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


Airway obstruction


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.


Runny Nose



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.


Muscle aches


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



Severe disability

Virtually eliminated with vaccine


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



Poorly recognized in early stages

High fever

Body aches


Disability and death

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

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