The Official Medtipster Blog

www.Medtipster.com Source: Chelsea Liebowitz, Intern, Pharm.D., Medtipster Mentorship Program – 6.18.14

All over Facebook and the news are articles regarding vaccinations. “Should I vaccinate my kid? Is it safe? Doesn’t it cause autism? Nobody really gets those diseases anymore anyways.” Comments on the articles posted on Facebook range from criticizing those who don’t vaccinate to hating on those who do. So who is right? To understand more about vaccines and why we need them, we first have to understand the harm the diseases caused before the vaccine was present. In this blog, we will discuss three different diseases: small pox, polio, and measles.

SMALL POX is an infectious disease which is characterized by a maculopapular rash, which later can turn into raised fluid-filled blisters. Long term complications include scars, commonly on the face, and less commonly, blindness and limb deformities.¹

Epidemics in Boston (1721) and London (1751) resulted in 844 deaths and 3,358 deaths respectively.² In 1882, rumors started saying that small pox was not spread by contagion but by filth.² This idea spread due to lack of modern science techniques, leading to neglect of vaccinations. Eleven years later, in 1893, another smallpox outbreak occurred. This ended with 140 people contracting the virus, with 20 deaths.² While the numbers are significantly lower than before, this is because another 13,000 were vaccinated to help stop the further spreading of the disease.² It wasn’t until 1980 that the virus was finally declared eradicated.²

POLIO, short for poliomyelitis, is an infectious viral disease that affects the central nervous system. This disease can then cause temporary or even permanent paralysis, and in some cases, death.¹

The first US polio epidemic occurred in 1894.² It resulted in 18 deaths and 132 cases of permanent paralysis.² Almost sixty years later, in 1952, a shocking 57,628 cases of polio were reported, with more than 21,000 cases including paralysis.²

In 1955, a polio vaccine clinical trial was shown to be 80-90% effective against paralytic polio.² Once the vaccine was being distributed to the general population, unfortunately there were strange cases of vaccinated patients still contracting the virus once they had been vaccinated. The strange part was that instead of the paralysis starting in the legs, like normal, the paralysis started in the vaccinated arm.² However, as more cases were reported, it was shown that the production of the vaccine was the issue, not the vaccine itself.²  A subcommittee, which included researchers and public health officials, made several changes to the production methods to ensure safety of the patient.² Some of the changes include testing larger samples of each vaccine lot, using filters that would remove clumps of  virus that might resist chemical inactivation, and also to test the vaccine once it was bottled.² Despite these changes some locations declined to participate due to the “dangerous nature” of the vaccine.²

In 1985, the World Health Organization set to eradicate polio in the Americas by 1990.² In 1988, the World Health Assembly voted to launch a global polio eradication (hopefully by 2000) due to polio being endemic in 125 countries.² The World Health Organization stepping in was a big step for polio eradication. Between 1988 and 2013, they successfully reduced the rates by 99%.² In 1994, polio was said to be eradicated in the Americas.²

Good news, right? Unfortunately, between 2013 and 2014, there has been an 86% INCREASE in wild polio virus (WPV). Eight countries have had outbreaks of polio, five of which were previously polio-free!⁴ What caused the increase in WPV cases? Experts believe the outbreak(s) was triggered by local leaders in North and South Waziristan having a ban on polio vaccinations.⁴ The ban prevented over 350,000 children from getting vaccinated. The unvaccinated children in these locations then spread the WPV to Pakistan, and from there it spread to Afghanistan and Syria.⁴ Once again, lack of vaccinations led to increases in infectious disease cases.

MEASLES is a respiratory disease and is highly contagious. Symptoms include fever, runny nose, cough and a rash all over the body. An ear infection or pneumonia may also be present.¹

In 1861, there were 21,676 reported cases and 551 deaths in the Union Army alone during the Civil War.² Two thirds of the 660,000 total soldier deaths were caused by uncontrolled infectious disease.² TWO THIRDS died not from fighting, but from some type of infectious disease, including measles. In 1951, a massive epidemic hits Greenland. Of the 4,262 population, all but five contracted the disease.² The attack rate was 99.9%.² Finally, in 1958, the measles vaccine started testing. It was successful in creating measles antibodies; however a rash was present as a side effect.² This told the researchers the virus needed to be weakened more before giving to patients. In 1962, a “dead strain” vaccine was tried, however it was ineffective.² The virus needs to be alive but weakened in order for the vaccine to be effective.  In 1963, the measles vaccine was licensed in the United States, and over the next 12 years, nearly 19 million doses were administered. In 1978, the CDC targeted to eliminate measles from the United States by 1982.² Unfortunately, the goal was not met, but by 1981, the number of reported cases went down 80% compared to the previous year. The CDC also noted that only 778 cases were reported in the first 14 weeks of 1981, while 3,897 cases had been reported during the same first 14 weeks of 1980.² This is a huge improvement, even if the goal of completely eradicating the disease was not met.

Between 1989 and 1991, 55,000 Americans contracted measles, killing 123.² In Philadelphia, 1,500 children fell ill and nine (all of which were not vaccinated) died.² Like with polio and smallpox, it was shown that outbreaks were centered in areas where immunization levels are low.² It took another 9 years (2000) until endemic measles was in fact eliminated from the united States.

So what do these three infectious diseases have in common? Even with the science to get rid of the disease, citizens who refused the vaccine are the starting point of epidemics that started after the vaccine came out. Repeatedly, when the technology was present and available, epidemics still happened. Polio was said to be eradicated in 1994. Today, polio is making a comeback across the globe due to unvaccinated children. How much longer until it reaches the United States? In 2000, endemic measles was eliminated. But through May 23 of this year, there is the highest year-to-date total number of measles cases since 1994.⁵ The CDC determined that most of the virus transmission is being done through individuals who travel outside the country, bring it back onto US soil, and infect those who are unvaccinated.⁵ This continues the spread, and due to the contagious nature, the disease can be spread very rapidly.

                Currently, small pox is still under control. But if people are refusing polio and measles vaccines, who says they won’t refuse the small pox vaccine? History tends to repeat itself. California has seen a rise in whooping cough (or pertussis), another disease that can easily be vaccinated for, with the number of infection nearly tripling since the previous year due to….low vaccination rates.³

                All three of these diseases are successfully preventable with simple vaccinations. Not only does vaccinating your child help protect them from potentially deadly diseases, but it can help stop the spread of the disease to other people. Many years of research and testing has been put into both the theory and practice of vaccines. While there are risks of side effects, the doctors giving the vaccines believe the benefits of the vaccine greatly outweigh the risks of the vaccine. Trust them! If you can’t trust your doctor, the professional who has spent years of his life in college and put himself into debt to get this career,  to give you the best care (which includes vaccinations), who can you trust?

                A common (and popular) myth associated with vaccines that I would like to quickly address is the myth that vaccines cause autism. THIS IS FALSE! From the CDC, “The 1998 study which raised concerns about a possible link between measles-mumps-rubella (MMR) vaccine and autism was later found to be seriously flawed, and the paper has been retracted by the journal that published it…There is no evidence of a link between MMR vaccine and autism or autistic disorders.”⁶

Just like in 1882, anti-vaccine ideas came about by saying smallpox was spread by filth, not contagion. The idea quickly spread, and in 1893, another smallpox outbreak occurred. Learn from this! The study claiming vaccines cause autism is FLAWED and has been RETRACTED by the journal that published it. The study is no longer valid.

Do you have more myths you are worried about? Check out this site http://www.who.int/features/qa/84/en/ to learn more about myths and the truth behind them all.

References

¹Center for Disease Control and Prevention (CDC). (2014). Retrieved from http://www.cdc.gov/

²The College of Physicians of Philadelphia. (2014). Diseases and Vaccines Timeline. The History of Vaccines. Retrieved from  http://www.historyofvaccines.org/content/timelines/diseases-and-vaccines

³Kearney, L. (April 24, 2014). California City Sees Spike in Whooping Cough Cases. Reuters Health Information. Retrieved from http://www.medscape.com/viewarticle/824067 

⁴Kelly, J. C. (June 02, 2014). Uptick in Worldwide Polio Cases in 2013 Continues Into 2014. Medscape Medical News. Retrieved fromhttp://www.medscape.com/viewarticle/826069  

⁵Lowes, R. (May 29, 2014). Measles Vaccine Refusal Helps Make 2014 a Record Year. Medscape Medical News. Retrieved from http://www.medscape.com/viewarticle/825913

⁶World Health Organization. (April 2013). What are some of the myths- and facts- about vaccination? Retrieved from http://www.who.int/features/qa/84/en/