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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. 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

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  1. Vaccination in Texas Vaccinations -- Guarding all of us…Protecting our Economy

  2. 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

  3. 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

  4. 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

  5. Comparison of Cases and Deaths for Vaccine-Preventable Diseases Vaccines Licensed before 1980 Source: JAMA

  6. Comparison of Cases and Deaths for Vaccine-Preventable Diseases Vaccines Licensed 1980 – 2005 Source: JAMA

  7. 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 Cough Airway obstruction Death

  8. Measles – Pre-vaccine 530,217 cases & 440 annual deaths. 200+ U.S. cases in 2011 highest since 1997. Rash Runny Nose Fever Cough Exquisitely contagious >90% attack rate for susceptible people European epidemic

  9. 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.

  10. 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.

  11. Mumps – Pre-vaccine 162,344 cases & 39 annual deaths. More than 6,500 annual cases & no recent U.S. deaths. Fever Muscle aches Fatigue Swollen salivary glands Orchitis with risk of sterility

  12. 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

  13. 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

  14. 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.

  15. 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

  16. HiB Disease 20000 affected children per year pre-vaccine Meningitis Epiglottitis Severe disability Virtually eliminated with vaccine

  17. Invasive HiBStory

  18. Influenza 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

  19. Meningococcal Disease Meningitis Meningococcemia Poorly recognized in early stages High fever Body aches Rash Disability and death

  20. Meningococcal Disease Story

  21. Vaccine Economics - Comparing Physician Costs to Selling Ice Cream

  22. Ice Cream and Vaccines • Similarities • Acquisition cost is variable • Perishable with defined shelf life • Maintenance costs • Provision costs • Liability for loss

  23. 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

  24. Ice Cream and Vaccines • Differences • Unit cost (financial risk) • Sales tax, vs. excise tax + franchise tax • Payment terms • Ice cream vs. I scream

  25. 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

  26. Ice Cream and Vaccines

  27. 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.

  28. 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

  29. 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

  30. Why Bother? Providing vaccines to a patient is the only medical service provided to an individual that benefits the rest of society

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