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IMMUNIZATIONS IN 2014

IMMUNIZATIONS IN 2014 . Head to toe conference may 2014. Lance Chilton, M.D. Professor, Pediatrics University of New Mexico. The reason we immunize. Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- United States, 1990-1998

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IMMUNIZATIONS IN 2014

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  1. IMMUNIZATIONS IN 2014 Head to toe conference may 2014 Lance Chilton, M.D. Professor, Pediatrics University of New Mexico

  2. The reason we immunize Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- United States, 1990-1998 At the beginning of the 20th century, infectious diseases were widely prevalent in the United States and exacted an enormous toll on the population. For example, in 1900, 21,064 smallpox cases were reported, and 894 patients died (1). In 1920, 469,924 measles cases were reported, and 7575 patients died; 147,991 diphtheria cases were reported, and 13,170 patients died. In 1922, 107,473 pertussis cases were reported, and 5099 patients died (2,3). Dramatic declines in morbidity have been reported for the nine vaccine-preventable diseases for which vaccination was universally recommended for use in children before 1990 (excluding hepatitis B, rotavirus, and varicella) . Morbidity associated with smallpox and polio caused by wild-type viruses has declined 100% and nearly 100% for each of the other seven diseases. MMWR, April 2, 1999

  3. Q: What is Still The most common vaccine-preventable disease?

  4. A: influenzaAKA: “Just the flu” Molinari et al. Vaccine 25 (2007) 5086–5096

  5. Influenza deaths in children

  6. New mexico’s school kids’ influenza immunization project X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

  7. Kudos to skiipand to all of you!

  8. Early Albuquerque data: Flu  school absences Gurule, Escareno, Dharas, Pentler, Skipper and Chilton, unpublished

  9. Doesn’t he ever stop talking about influenza? He does.

  10. Where do immunization recs come from? • American Academy of Pediatrics Committee on Infectious Diseases (Red Book Committee) : meets twice a year, produces Red Book every 3 years • ACIP – Next Meeting: June 25-26, 2014, Atlanta • Informational items • Votes

  11. Red book committee

  12. Screen for Powerpoints Podium Larry Pickering Jonathan Tempte Head Table Audience Audience L L M M ACIP Members Liaisons Audience

  13. ACIP Products www.cdc.gov/vaccines

  14. A bit about vaccine safety

  15. Are vaccines safe?AND WHAT’S VAERS ANYWAY? Vaccine Adverse Effects Reporting System

  16. VSD

  17. The vaccine safety datalink This is the most robust vaccine safety system; there are others (example: military).

  18. The rotashield® story (born 1998, died 1999) • Rotavirus kills some 450,000 children per year around the world; 20-60 in the United States • Early 1990s , clinical trials showed 80-100% effectiveness against severe rotavirus diarrhea and excellent safety profile • 1998: RotaShield licensed • Late 1998: reports to VAERS of many cases of intussusception after RotaShield receipt • VAERS Signal reported to VSD, which affirmed the hypothesis that RotaShield associated with intussusception • 1999: Rotashield removed from market. • Early 2000s, clinical trials on far more children showed no association with intussusception for two new vaccines, Rotarix® and Rotateq® • 2006: Rotarix and Rotateq approved by FDA and recommended by ACIP SUCCESS OR FAILURE OF THE VACCINE SAFETY SYSTEM?

  19. HOW SHOULD WE COMMUNICATE HOW SAFE VACCINES ARE?

  20. Penn and teller’s approachto vaccine safety discussion Viewer Discretion Advised

  21. Paul offitt’sapproach

  22. Dr. bob sears’approach

  23. Dr. sears’ vaccine schedule

  24. Too many antigens? • 2012: 2 month shots: • Antigens: • Rotavirus 5 • Pediarix • Diphtheria 1 • Tetanus 1 • Pertussis 3 • Polio 3 • Hepatitis B 1 • H. Influenzae B 1 • Pneumococcal 13 • Total 28 Streptococcal Infection = 25-50 antigens Upper respiratory infection = 4-10 antigens In the old days: Smallpox vaccine = ~200 antigens Whole cell pertussis vaccine = ~3000 antigens

  25. Declining number of antigens:

  26. Vaccines aren’t free • But no, folks, you won’t have to pay for vaccines in New Mexico (yet).

  27. In 42 states… • But only for • Uninsured • Native Americans/Alaska Natives • Medicaid insured • Underinsured • But only in FQHC or RHC

  28. In 6 states (NH, RI, VT, WI, WY and… New mexico!) • For all children and adolescents before their 19th birthday Alaska, Hawaii, Maine, Massachusetts, South Dakota, Washington cover most but not all childhood vaccines

  29. Are these vaccines affordable? • In Arizona, Colorado, Utah, Texas and most other states, the total private sector price of all vaccines for each person (except influenza) through age 18 was $2171 + vaccine administration as of April 2014. • In New Mexico, the price to patients is $0 + vaccine administration Vaccines for Children for everyone in New Mexico is under attack!

  30. Why is this important? Vaccines for the first five years Vaccines for adolescence April 1, 2014, CDC data

  31. Is it worth it? FIGURES FOR ONE BIRTH COHORT – 2009: 4.26 MILLION BIRTHS Cost:benefit ratio Direct costs only: 3.0 Total societal costs: 10.1 THAT’S $20 BILLION and $76 BILLION! DEATHS Zhou F et al. Economic Evaluation of the Routine Childhood Immunization Program in the US, 2009. Pediatrics, 2014. 133:577.

  32. RESULTs… VACCINE for everyone else VFC VACCINE $90,000

  33. That’s the business side; how about the personal context?

  34. This is why we do it…

  35. My patient, post hib meningitis Age 34

  36. How’re we doing on individual adolescent vaccines? 90 80 70 60 50 40 30 20 10 HOW DO THEY DO THAT? UK Vaccines for Children for everyone in New Mexico is under attack! ? CDC 2012 NIS data in MMWR, Aug. 30, 2013

  37. Cervical cancer in new mexico New Mexico Tumor Registry, 2006-2010 data

  38. Prevalence of individual human papillomavirus (HPV) types among females aged 14–19 years, 2003–2006 and 2007–2010. Markowitz L E et al. J Infect Dis. 2013;208:385-393 Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013.

  39. Special communiqué from the front HPV vaccination does not cause teenagers to have sex Mayhew A et al. Sexual Behaviors after HPV Vaccination. Pediatrics, 2014. 133:404.

  40. SHOULD WE GIVE MORE VACCINES IN NEW MEXICO SCHOOLS? • No • School nurses already have too many tasks • Some vaccines are too controversial • Yes • That’s where the kids are! • We could teach about the diseases prevented

  41. Thank you for all you do! • "Schools have a wealth of potential for ensuring the future well-being of young people. You can't educate a child who isn't healthy, and you can't keep a child healthy who isn't educated." • -- M. Jocelyn Elders, MD

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