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An Underappreciated Component
     of the Modern Medical
• 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)
• Contain live viruses
• Attenuated tend to mimic an actual infection and
  usually provide better and longer lasting
• 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
– 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
• D (dephtheria toxoid) T (tetnus toxoid)
  aP (acellular pertussis toxoid and surface
  – subunit vaccine that is very safe
  – Soluble, elicit a humoral response
• Old pertussis vaccine was made from
  inactivaed whole unit bacteria (Bordetella
• 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

• 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

• 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
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

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
• 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
• Numerous lawsuits based on alleged, rare side
  effects of vaccines.
       Comparison of global military spending and
   spending on prevention of infectious diseases.



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
• 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
• 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
• 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
• 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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