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Vaccination An Underappreciated Component of the Modern Medical Armamentoarium Vocabulary • Vaccine: – A preparation that contains microorganisms or their parts to which immune systems responds to. • Toxoid: – An inactive toxin that is no longer harmful but retains its unique Ag determinants. Types of Vaccines • 2 Types of vaccines – Whole-agent • Attenuated (Weakened) • Inactivated (killed) – Subunit (some part of agent) Attenuated • Contain live viruses • Attenuated tend to mimic an actual infection and usually provide better and longer lasting immunity. • Replicates in the body, increasing the original dose over time provides herd immunity • Life long Without boosters • Examples measles, rubella, mumps, oral polio Attenuated Vaccines Cont. • Attenuated viruses are usually derived from mutations accumulated during long term cell cultures. • Danger of such vaccine is that they can back mutate to a virulent form, although this very rarely happens. Innactivated Vaccines Whole Organisms that have been killed – Usually killed by formulin – Never killed by heat. Why? – Boosters: Because immunity is not always long lasting boosters are needed to maintain immunity. – Examples; rabbies, influenza vaccines Subunit vaccines • Vaccines in which antigenic fragments of microrganisms that are best suited to stimulate immune resp. • Recombiant vaccines – example Hepatitis B virus – Portion of the viral protein coat. – (Less effective) - safer Cannot reproduce in host contain little or no extraneous material thus – less side effects DTaP • D (dephtheria toxoid) T (tetnus toxoid) aP (acellular pertussis toxoid and surface adhesin) – subunit vaccine that is very safe – Soluble, elicit a humoral response • Old pertussis vaccine was made from inactivaed whole unit bacteria (Bordetella pertussis) Immunizations • Idaho is ranked 50th in immunization for children 19-35 months of age. – 4:3:1 – 4 doses of DTP – 3 doses of oral polio – 1 dose of measles vacine Is the MMR Vaccine Safe? • Researchers in the UK studied the records of 498 children with autism born between 1979 and 1998. They found: • The percentage of children with autism who received MMR vaccine was the same as the percentage of unaffected children in the region who received MMR vaccine. • There was no difference in the age of diagnosis of autism in vaccinated and unvaccinated children. • The onset of "regressive" symptoms of autism did not occur within 2, 4, or 6 months of receiving the MMR vaccine. A Larger Study in Japan • The Japanese MMR vaccination program targeted one-year-olds between April 1989 and April 1993, then was discontinued. • Therefore, children born during the years 1988 to 1992 received the MMR vaccine. • According to Yokohama statistics, MMR vaccination rates declined from 69.8% in the 1988 birth cohort, to 42.9%, 33.6%, 24.0%, and a mere 1.8% in birth cohorts 1989 to 1992. • What was the effect on Autism? No effect of MMR withdrawal on the incidence of autism: a total population study Cohort total = 31,426 individuals 69.8% 42.9% 33.6% 24.0% received 1.8% 0.0% MMR received MMR Journal of Child Psychology and Psychiatry 46 (6), 572–579. An association is not the same as ―cause and effect.‖ Other environmental factors have been associated with autism. ―Involunteer experiment‖ • 1980-sensationalized and highly inaccurate news accounts of alleged side effects of pertussus caused many parents in the United Kingdom to refuse the pertusus toxoid in DTP. • An epidemic of whooping cough occurred in the United Kingdom, in which 100,000 children were infected and 36 died. Many of the survivors sustained brain damage. Most parents today have never seen a case of diphtheria, measles, or other once-common diseases now preventable by vaccines. As a result, some parents wonder why their children must receive shots for diseases that do not seem to exist. Annual morbidity before the vaccine became available compared to morbidity in 1998 Disease Annual 1998 % Decrease morbidity morbidity Smallpox 48,164 0 100 Diphtheria 175,885 1 100 Pertussis 147,271 6,279 95.7 Tetanus 1,314 34 97.4 Polio 16.317 0 100 Measles 503,282 89 100 Mumps 152,209 606 99.6 Rubella 823 5 99.4 Why aren’t there more Vaccines? • Many of the barriers to vaccine development are financial, legal, and political rather than scientific. • Vaccines are not nearly as profitable as mind altering drugs or heart medications. • The development of vaccines have focused on diseases that are widespread and usually not serious. • Numerous lawsuits based on alleged, rare side effects of vaccines. Comparison of global military spending and spending on prevention of infectious diseases. Spending Deaths Link Vaccines-a Health Care Bargain • A good vaccine can provide lifelong immunity to an infectious disease. • Vaccines are much cheaper than diagnosis and treatment of infections after they have started • They prevent human suffering and may be the only form of treatment known for some ailments. Vacinations • Vaccines currently under development – Contraception – Cancer – cocaine addiction • There is no absolute limit to the number of vaccines that can be safely given to a person. – All standard vaccines recommended for children can be given to the same person, at separate anatomical sites, on the same day – It is safe to give mildly sick children vaccinations Vaccine Against Cancer • If there was a vaccine on the market which protected you from cancer would you take it? Gardasil • A new recombinant vaccine that protects women from cervical cancer. • Cervical cancer is the second leading cause of cancer death among women in the world, killing more than 250,000 a year. • The vast majority of cervical cancer is caused by the Human Papilloma Virus (HPV). – This is a very common virus. By the age of 50, about 80% of all women have been infected by it at one point or another. – HPV is sexually transmitted • Is Gardasil safe? – Test conducted on over 11,000 people showed only minor problems. Some people had a slight fever. Others complained of redness or irritation on the skin at the site of the injection. • Is Gardasil effective? – The vaccine is between 95-100% effective against HPV types 6, 11, 16, 18 if taken prior to infection. • How is Gardasil made? – Gardasil is a non infectious recombinant vaccine made from highly purified virus like particles of the major capsid protein L1. • Should Gardasil be made mandatory? Manditory Vs. Morals • The catch with this vaccine has nothing to do with its effectiveness or its safety. • The catch is that Human Papilloma virus is sexually transmitted. • Cure For Cancer Cancer in Utah Mormon women by church activity level. Gardner JW, Lyon JL In light of low cancer rates by the Mormon Church, this study classifies female Mormon cancer patients in Utah according to measures of adherence to Church doctrines. The distribution by Church activity level is compared for each site to a group of other cancer sites felt to represent the overall activity level distribution of Utah Mormon women. Mormon women classified as having the strongest adherence to Church doctrines had lung cancer rates during 1966-1970 much lower than did women with the weakest adherence. The relationship was not as strong, however, as that seen in Mormon men when classified by lay priesthood office. Cancer of the uterine cervix also showed lower rates in the more active groups, but this finding was not statistically significant. Cancers of the breast and ovary did not show consistent associations with Church activity level, nor did most of the gastrointestinal cancers. These data suggest that some of the differences in cancer incidence between Mormons and non-Mormons may not be explained by adherence to specific Church doctrines. Am J Epidemiol. 1982 Aug;116(2):258-65. Health Care and African Americans • As a group, many older African Americans are skeptical of govt. run health programs and immunizations. • Much of the skepticism stems from a govt. run study conducted in Tuskegee Alabama from 1932 to 1972. Tuskegee Syphilis Study • was a clinical study conducted between 1932 and 1972 in Tuskegee, Alabama, in which 399 poor — and mostly illiterate — African American sharecroppers were studied to observe the natural progression of the disease if left untreated. • the Tuskegee scientists withheld penicillin and information about penicillin, purely to continue to study how the disease spreads and kills. Participants were also prevented from accessing syphilis treatment programs that were available to other people in the area. The study continued until 1972, when a leak to the press resulted in its termination. • Listen to Alex Chadwick's report.
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