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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

  • 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 – Diseases21,053 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 Diseases – 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 Diseases

    • 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 – DiseasesOutbreak 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 – DiseasesPre-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) Diseases

    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 Diseases

    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 in Williamson County, Texas, 2009*

    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 in Williamson County, Texas, 2009*

    20000 affected children per year pre-vaccine



    Severe disability

    Virtually eliminated with vaccine

    Invasive hib story
    Invasive in Williamson County, Texas, 2009* HiBStory

    Influenza in Williamson County, Texas, 2009*

    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 in Williamson County, Texas, 2009*



    Poorly recognized in early stages

    High fever

    Body aches


    Disability and death

    Meningococcal disease story
    Meningococcal Disease Story in Williamson County, Texas, 2009*

    Ice cream and vaccines
    Ice Cream 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 - Cream 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 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 - Cream 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 Cream

    • 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 Cream

    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 Cream

    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 Cream Bother?

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