Lance Chilton MD Professor Pediatrics University of New Mexico The reason we immunize Achievements in Public Health 19001999 Impact of Vaccines Universally Recommended for Children United States 19901998 ID: 657038
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Slide1
IMMUNIZATIONS IN 2014
Head to toe conference may 2014
Lance Chilton, M.D.
Professor, Pediatrics
University of New MexicoSlide2
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, 1999Slide3
Q: What is Still The most common vaccine-preventable disease?Slide4
A: influenza
AKA: “Just the flu”
Average Annual United States Incidence of Influenza Outcomes
Under 5 Years
5-17 Years
Total Population
“Just sick”
2,030,000
3,296,000
12,414,000Outpatient visit1,741,0001,535,0007,282,000Hospitalized54,3432,805195,776Deaths1424321,282
Molinari et al.
Vaccine 25 (2007) 5086–5096Slide5
Influenza deaths in childrenSlide6
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New
mexico’s
school kids’ influenza immunization projectSlide7
Kudos to skiip
and to all of you!Slide8
Early Albuquerque data: Flu
school absences
Gurule
,
Escareno
,
Dharas
,
Pentler
, Skipper and Chilton, unpublishedSlide9
Doesn’t he ever stop talking about influenza?
He does.Slide10
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
VotesSlide11
Red book committeeSlide12
Screen for Powerpoints
Head Table
Members
M
M
L
Liaisons
L
Audience
Audience
Audience
Podium
ACIP
Jonathan
Tempte
Larry PickeringSlide13
www.cdc.gov/vaccines
ACIP ProductsSlide14
A bit about vaccine safetySlide15
Are vaccines safe?
AND WHAT’S VAERS ANYWAY?
Vaccine Adverse Effects Reporting SystemSlide16
VSDSlide17
The
vaccine safety
d
atalink
This is the most robust vaccine safety system; there are others (example: military).Slide18
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
receiptVAERS Signal reported to VSD, which affirmed the hypothesis that RotaShield associated with intussusception1999: 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 ACIPSUCCESS OR FAILURE OF THE VACCINE SAFETY SYSTEM?Slide19
HOW SHOULD WE COMMUNICATE HOW SAFE VACCINES ARE?Slide20
Penn and teller’s approach
to vaccine safety discussion
Viewer Discretion AdvisedSlide21
Paul
offitt’s approachSlide22
Dr. bob sears’
approachSlide23
Dr. sears’ vaccine scheduleSlide24
Too many antigens?
2012: 2 month shots:
Antigens:
Rotavirus 5
Pediarix Diphtheria 1Tetanus 1
Pertussis 3Polio 3
Hepatitis B 1
H.
Influenzae
B 1Pneumococcal 13Total 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 antigensSlide25
Declining number of antigens:Slide26
Vaccines aren’t free
But no, folks, you won’t have to pay for vaccines in New Mexico (yet).Slide27
In 42 states…
But only for
Uninsured
Native Americans/Alaska Natives
Medicaid insured
Underinsured
But only in FQHC or RHCSlide28
In 6 states (NH, RI, VT, WI, WY and…
For all children and adolescents before their 19
th
birthday
New
mexico
!)
Alaska
, Hawaii, Maine, Massachusetts, South Dakota,
Washington cover most but not all childhood vaccinesSlide29
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!Slide30
Vaccine
Doses
Total
Pediarix
3
$211
Rotateq
3
$226
Hib4$93Pneumo4$543MMR2$112Varivax2$188Hep A2$61DTaP2$21Polio IPV
1
$27
TOTAL
$1482
Vaccine
Doses
Total
Gardasil
3
$425Menactra2$226Tdap1$38TOTAL$689Why is this important?
Vaccines for the first five yearsVaccines for adolescenceVaccine Total Cost per Child$2171plus Influenza Vaccine, $8-23/dose
April 1, 2014, CDC dataSlide31
Is it worth it? FIGURES FOR ONE BIRTH COHORT – 2009: 4.26 MILLION BIRTHS
Disease
Cases Prevented
Deaths Prevented
Direct Costs Saved, Million $
Societal Costs Saved (Direct + Indirect), Million $
Diphtheria
275 028
27 503
365439 296Tetanus16925
12
45
Pertussis
2 950 836
1062
4443
7017
Hib
19 606
74118103756Polio
67 46380028987259Measles3 835 8253106
37628862Mumps2 312 2751214112374Rubella
1 981 06615187721Congenital rubella syndrome63270
133257HepB239 99335142401770
Varicella3 942 546733731598HepA153 16436
52114Pneumococcus-related diseasesb2 323 95250569652696
Rota1 582 94019327595Total19 685 495
42 03220 26776 360DEATHSTHAT’S $20 BILLION and $76 BILLION!
Cost:benefit ratioDirect costs only: 3.0Total societal costs: 10.1Zhou F et al. Economic Evaluation of the Routine Childhood Immunization Program in the US, 2009. Pediatrics, 2014. 133:577.Slide32
RESULTs…
VFC
VACCINE
VACCINE
f
or everyone else
$90,000Slide33
That’s the business side; how about the personal context?Slide34
This is why we do it…
Disease
Annual Cases – Pre-Vaccine Era
Annual Cases
Since Vaccine
Percent
Reduction
Diphtheria
175,885
0100%Tetanus13142898%Measles503,2824399.9%Mumps152,20980099.5%Rubella47,7451299.9%Congenital Rubella Syndrome823
0
100%
Polio
16,316
0
100%
Haemophilus
influenzae b20,0005499.7%Slide35Slide36
My patient, post hib
meningitis
Age 34Slide37
How’re we doing on
individual adolescent vaccines?
?
CDC 2012 NIS data in MMWR, Aug. 30, 2013
UK
90
80
70
60
50
40
30
20
10
HOW DO THEY DO THAT?
Vaccines for Children for everyone in New Mexico is under attack!Slide38
Cervical cancer in new mexico
I
n
c
id
en
c
e
Race/EthnicityAge-adjusted rateAverage
n
u
mb
e
r
o
f n
ew casesPercent of all
new casesRank among all new cancer cases†
NM, Non-Hispanic White6.532
1.3%13NM, Hispanic9.0
352.8%10NM, American Indian
6.562.7%13NM, Black
5.212.0%11NM, All Races C
ombined*761.9%*
US, All Races Combined§7.411,070
1.6%13Mortality
Race/EthnicityAge-adjustedrate
Average numberof cancer deathsPercen
t of allcancer deathsRank among al
l cancer deaths†NM, Non-Hispanic White
1.7101.1%15NM, H
ispanic3.1122.6%12
NM, American Indian3.533.5%10
NM, Black----
NM, All Races Combined*261.7%
*US, All Races Combined§2.4
3,8701.4%14
New Mexico Tumor Registry, 2006-2010 dataSlide39Slide40
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.Slide41
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.Slide42
Yes
That’s where the kids are!We could teach about the diseases prevented
No
School nurses already have too many tasks
Some vaccines are too controversial
SHOULD WE GIVE MORE VACCINES IN
NEW MEXICO SCHOOLS?Slide43
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