H5N1

UNICEF cuts cost of vaccine that protects against five diseases

Via The New York Times, some good news: Unicef Cuts Cost of Vaccine That Protects Against 5 Diseases. Excerpt:

The United Nations Children’s Fund has made a deal with six vaccine manufacturers that will cut in half the price of a shot that protects children against five diseases, the fund announced last week.  

The deal will mean three years’ worth of vaccine at an average price of 84 cents a dose; buyers currently pay about $1.84, according to Unicef. 

Unicef will buy about 450 million doses for 80 of the world’s poorest countries. Low- and middle-income countries purchasing vaccine for themselves can also qualify for the lower prices, Unicef said. 

The vaccine protects against diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenzae Type B (known as Hib). Gavi, the Vaccine Alliance, estimates that the shots will prevent more than five million deaths by the year 2020.  

In 2001, only one company made the so-called pentavalent vaccine. As more companies have started offering it, Unicef has forced them to compete by holding several rounds of bidding for large contracts and publishing all of the prices that were offered. 

Another advantage of an expanded market is that vaccine plants can develop sterility problems that force them to shut down for cleaning and repairs. Having multiple manufacturers ensures against shortages, which can be disastrous during epidemics. 

Measles shots and doses of vitamin A are among the chief reasons t the number of children who die before reaching age 5 has dropped sharply. The number was about 10 million a year 10 years ago; it is now approaching five million a year.  

But the diseases prevented by the pentavalent vaccine kill many of the youngest infants. Progress saving those lives has been slower. The Hib bacterium alone, for example, kills about 350,000 children a year.

WHO on World Immunization Week 2016: Immunization game-changers should be the norm worldwide

A news release from WHO: World Immunization Week 2016: Immunization game-changers should be the norm worldwide. Excerpt:

During World Immunization Week 2016, held 24-30 April, WHO highlights recent gains in immunization coverage, and outlines further steps countries can take to “Close the Immunization Gap” and meet global vaccination targets by 2020. 

“Last year immunization led to some notable wins in the fight against polio, rubella and maternal and neonatal tetanus,” says Dr Margaret Chan, WHO Director-General. “But they were isolated wins. Polio was eliminated in 1 country, tetanus in 3, and rubella in 1 geographical region. The challenge now is to make gains like this the norm.” 

Immunization averts 2 to 3 million deaths annually; however, an additional 1.5 million deaths could be avoided if global vaccination coverage improves. Today, an estimated 18.7 million infants – nearly 1 in 5 children – worldwide are still missing routine immunizations for preventable diseases, such as diphtheria, pertussis and tetanus. 

In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP), a commitment to ensure that no one misses out on vital immunizations. Despite gains in vaccination coverage in some regions and countries the past year, global vaccination targets remain off track. 

Global Vaccine Action Plan 2011 - 2020

Only 1 out of 6 targets is on track — the introduction of new or underutilized vaccines in low- and middle-income countries. During the past 5 years, 86 low- and middle-income countries have made 128 introductions of the following vaccines: Hib-containing vaccine, pneumococcal conjugate vaccine (PCV), rotavirus vaccine, human papillomavirus vaccine (HPV), rubella and inactivated polio vaccine. The target is to introduce 1 or more new or underutilized vaccines in at least 90 low- and middle-income countries by 2015.

CIDRAP: Study relates vaccine refusal to rise in measles, pertussis

Via CIDRAP, Lianna Matt writes: Study relates vaccine refusal to rise in measles, pertussis. Excerpt:

A review of 18 measles studies and 32 pertussis studies published last week in the Journal of the American Medical Association (JAMA) found that parents who intentionally do not have their children vaccinated contribute to disease outbreaks, though other factors are likely at work, as well. 

Measles and pertussis (whooping cough), both highly contagious, are on the rise in the United States. Measles was declared eradicated from the United States in 2000 but has recently resurged, with 667 cases in 2014 and 189 in 2015, according to the Centers for Disease Control and Prevention (CDC). Pertussis dropped to fewer than 2,000 US cases for several years in the 1970s and '80s before roaring back to more than 48,000 cases in 2012, a 60-year high, according to the CDC. 

The JAMA meta-analysis, conducted by a team led by Emory University researchers, involved 1,416 measles cases and 10,609 pertussis cases across the 50 studies. 

Exemptions from measles vaccination 

The experts looked at measles outbreaks from 2000 until November 30, 2015, including an outbreak linked to Disneyland in 2014 and 2015 that involved 111 cases. 

Of the 1,416 cases analyzed, 56.8% had no vaccination history, the authors found. They also noted that, of the 970 measles cases with detailed vaccination data, 574 patients (59.2%) were unvaccinated despite being vaccine eligible, and 405 of those (41.8% of the total) had nonmedical exemptions—for religious or philosophical reasons, as opposed to medical reasons.  

Those rates compare with 14.1% of outbreak case-patients having received a vaccine, and the remaining cases being ambiguous. 

One of the 18 studies that the researchers analyzed claimed that children who are not fully vaccinated are 35 times more likely to become infected with measles. 

In a subset of the studies that the authors looked at, in seven reports cataloguing 574 unvaccinated patients, 70.6% had specifically opted out of receiving the vaccine for nonmedical reasons. The authors note, however, "Sometimes it is difficult to distinguish between purely religious or philosophical objections to immunization and safety concerns about vaccines that manifest as nonmedical objections" for all diseases, not just measles. 

Pertussis opt-outs 

For pertussis, the researchers noted that the five largest statewide epidemics quantified among the 32 studies had 24% to 45% rates of unvaccinated or under-vaccinated patients. The team also noted that, in 8 of 12 outbreaks from 9 studies that included detailed vaccination data on unimmunized patients, 59% to 93% of unvaccinated people were intentionally not vaccinated. 

However, simply increasing vaccination rates would not solve the pandemic, the authors wrote. "We also found reports of epidemics within populations with high rates of vaccination coverage, illustrating the important contribution of waning immunity to pertussis to disease epidemiology."

Picard: Canadian Medical Association wants schools to seek proof of vaccination

Via The Globe and Mail, André Picard writes: Canadian Medical Association wants schools to seek proof of vaccination. Excerpt:

Every student in Canada should be required to present a “declaration of immunization” before being admitted to school, the country’s top doctors’ group says. 

The Canadian Medical Association stopped just short of calling for mandatory vaccination, but said much more must be done to figure out who is not vaccinated against once-common childhood diseases, and that parents who do not fully vaccinate should be obliged to explain why to public-health officials. 

“The goal is to know the vaccination status of every child,” Jun Yen, a public-health physician from Gatineau, said at the CMA’s annual meeting. 

Dr. Yen said this would make it easier to identify unvaccinated children when there are outbreaks of disease, and allow public-health officials to educate parents on the benefits of immunization. 

Cindy Forbes, the president of the CMA and a Halifax family physician, said doctors are firm believers in vaccination but don’t want it to be mandatory because that “inflames the conversation.” 

“We feel education is the way to go,” she said, adding that most parents who don’t fully vaccinate have concerns, but they are not dogmatically anti-vaccine. 

“We think this will improve immunization rates,” Dr. Forbes said. 

Currently, some provinces require proof of immunization for daycare or school admission, but the rules vary by jurisdiction and adherence to the rules can vary from school to school. 

It can also be difficult for parents to track down this information because, in many provinces, it is collected by family doctors up to age 5, then by schools after that age. Electronic health records, where they exist, also tend to not be connected to vaccine databases. 

The CMA also called for the creation of a national vaccine registry so all information is stored centrally and securely. This is particularly important because, in recent years, there have been a growing number of outbreaks such as measles, mumps and whooping cough.

Case in point: Alberta Health today declared a pertussis outbreak in the northern part of the province, with 182 cases so far. Northern Alberta is the realm of the oil sands, now in a state of economic collapse; it's always had a transient population of young men and young families, which must now be moving elsewhere in search of jobs. Vaccinating their kids is not likely top of mind for them.

Canada's high vaccination rates still need improvement, study finds

Via The Globe and Mail: Canada's high vaccination rates still need improvement, study finds. Excerpt:

New numbers show close to 90 per cent of Canadian toddlers have been vaccinated against diseases such as measles, mumps and rubella, but health experts say more needs to be done to raise immunization rates. 

The 2013 Childhood National Immunization Coverage Survey reported immunization rates among two-year-old children in Canada. Coverage rates for measles, mumps and rubella among the children stood at about 89 per cent, and 91 per cent for polio. Rates for diphtheria, pertussis and tetanus were lower at about 77 per cent, and varicella – or chicken pox – had 73-per-cent coverage.

The latest numbers come at a time when concerns about recent measles outbreaks have made headlines across the country, including an outbreak in Quebec that surged to more than 100 confirmed cases in March. 

The survey also examined parents’ attitudes toward immunization and found that 1.5 per cent of the children included in the survey had never had any vaccines. Some children cannot be vaccinated due to other illnesses. 

A spokesperson for the Public Health Agency of Canada said in a statement that the study shows the country has “high vaccination coverage rates,” but “the results underscore the need for continued attention to issues such as vaccine hesitancy and under-immunization.” 

Gregory Taylor, Canada’s chief public health officer, said that with 5,500 respondents, the survey about children’s vaccination status is the largest ever commissioned by the Public Health Agency of Canada (PHAC). The previous survey in 2011 involved 400 parents and guardians.

Canada: Seven children in one family contract pertussis

Via CBC News: Tara Hills, Ottawa mom, changes anti-vaccination stand before 7 kids get sick. Click through for the full report and a video. Excerpt:

An Ottawa mother of seven "defected" from the anti-vaccination movement, but then her youngest — a 10-month-old son — contracted whooping cough before she could get all of her children their shots. 

Tara Hills told CBC News that since all her children, aged 10 and under, were showing symptoms of the contagious disease, they have been advised to take antibiotics and stay inside their Kanata home for five days.   

Her first three children were partially vaccinated, she said. But she decided to stop after the fourth was born because she was suspicious of the medical community. 

"I just got scared. I got spooked. I thought, 'There's a lot of smoke, there must be fire.' We stopped vaccinating," she said.  

Hills said she had recently started rethinking her position on vaccinations. Before her youngest was diagnosed with whooping cough, she said, she met with her family doctor to put together a "catch-up vaccination schedule" for her children. 

"It's very sobering and it's very raw because we had just made a more fully informed decision about vaccinations. We had just defected from the anti-vaccination camp," she said.  

"It was too late. It's so ironic and I'm not beating myself up for it. I just hope we can use this very painful experience to encourage other people like us to maybe re-examine the issue."

WHO: Vaccination must be scaled up in Ebola-affected countries

WHO has published a news release: Vaccination must be scaled up in Ebola-affected countries. Excerpt:

A growing risk of outbreaks of measles, pertussis, and other vaccine-preventable diseases in countries affected by Ebola must be countered by urgent scaling up of routine immunization activities, according to the World Health Organization (WHO). 

“We are calling for the intensification of routine immunization services in all areas, and for mass measles vaccination campaigns in areas that are free of Ebola transmission,” says Dr Jean-Marie Okwo-Bele, Director of Immunization, Vaccines and Biologicals at WHO. 

The Ebola outbreak, which has infected some 24,000 people and killed around 10,000 of them, has also reduced vaccination coverage in Guinea, Liberia and Sierra Leone, as health facilities and staff focus on halting the outbreak. 

“Any disruption of immunization services, even for short periods, will result in an increase in the number of susceptible individuals, and will increase the likelihood of vaccine-preventable disease outbreaks,” according to a WHO note sent to countries this week. 

The new guidance for immunization programmes in the African Region in the context of Ebola to help countries maintain or restart immunization services includes infection control precautions for health workers. The document notes that for countries not affected by Ebola, routine immunization and surveillance “should continue using the normal safe injection and waste disposal practices.” 

Mass vaccination campaigns for measles in areas that are free of Ebola transmission should be implemented to reduce the risk of significant measles outbreaks, the guidance notes. 

During the Ebola outbreak, people infected with malaria have been unable to get treatment, either because they have been too afraid to seek help at health centres or because such facilities have been closed. 

To rapidly reduce the malaria burden and the number of febrile people with malaria presenting at Ebola evaluation facilities, WHO recommended mass drug administration (MDA) of anti-malarial medicines to all eligible people in areas heavily affected by Ebola. 

MDA campaigns with first line anti-malaria drugs were carried out in Sierra Leone and Liberia from October 2014 to January 2015, reaching an estimated 3 million people through door-to-door distribution, reducing malaria and the risk of Ebola transmission to malaria patients.

Homeopathic vaccine warning labels not enough, doctors tell Health Canada

Via CBC News: Homeopathic vaccine warning labels not enough, doctors tell Health Canada. Excerpt:

Ineffective homeopathic alternatives to vaccines should be taken off the market because they are a dangerous distraction, public health officials urge as infectious diseases such as measles make a comeback. 

Some naturopaths, homeopaths and chiropractors sell homeopathic nosodes described as a diluted remedy of bacteria or virus. They are most often given orally, but can be injected as well. 

Health Canada says the packages need to be labelled with a warning: "This product is not intended to be an alternative to vaccination." 

Last year, CBC-TV's Marketplace found homeopathic practitioners telling parents nosodes were as effective as vaccines against diseases such as measles, polio and pertussis (whooping cough), which is highly contagious and can be fatal for infants. 

"There's no evidence to support their claims at all around providing immunity against infectious diseases," said Dr. Robert Strang, Nova Scotia’s chief public health officer. "I think, frankly, having them available on the market is dangerous. It's distracting and it's helping people avoid immunization or giving them a reason not to be immunized."

Strang said in 2013 his provincial and territorial colleagues wrote to Health Canada to request nosodes be pulled from the market. He repeated his call on Tuesday.   

"Those warning labels really aren't having an impact," Strang said. 

In Ontario, where 16 cases of measles have been identified, Ontario health minister Dr. Eric Hoskins said vaccination is the only way to protect yourself and those around you from the highly infectious disease. 

"There's no such thing as a homeopathic or a naturopathic vaccine," Hoskins said. "The only way you can protect yourself is by being vaccinated. So it does worry me anytime that there is misinformation out there in the public domain."

US: University of California to require measles vaccinations

Via The New York Times, an Associated Press report with a misleading headline: California: Colleges to Require Measles Vaccinations. It's just UC (so far).

University of California students will have to be vaccinated against measles and other diseases under rules that take effect in 2017. 

Officials who announced the changes on Friday said the plan had been in the works but took on new urgency after a measles outbreak at Disneyland in December that has spread to a half-dozen states and Mexico. 

The university now requires students to be inoculated against only hepatitis B. The new rules will require vaccination for measles, tuberculosis, chickenpox, whooping cough and meningitis. 

California public health officials said Friday that the number of measles cases in the state had risen to 103, four more than two days earlier.

Picard: Vaccination is for the greater good

Via The Globe and Mail, health reporter André Picard writes: Vaccination is for the greater good. Excerpt:

The outbreak of measles in the United States, which began at Disneyland in mid-December, has brought an age-old question to the surface anew: Should childhood vaccination be mandatory? 

In an ideal world, the answer would be “no” – because every parent would do the rational and socially responsible thing and have their children vaccinated to protect them and others around them from dreadful illnesses such as measles, mumps, chickenpox and whooping cough. 

But we live in an era of fear, not reason. A small but significant number of parents have, for a variety of reasons, come to fear vaccines more than they fear infectious diseases. 

So how do we, in a democratic society, deal with them? 

First, we have to understand who “they” are. There is no massive anti-vaccination movement. The vast majority of Canadian children – roughly 90 to 95 per cent – are vaccinated by the time they enter school at age 5. Only about 2 per cent of parents are intractably against vaccinations – an oddball group of conspiracy theorists and religious zealots. 

In recent years, however, we have seen the emergence of a rapidly growing group of skeptics, parents with a hodgepodge of doubts and fears, real or imagined. 

They believe vaccines are being rammed down their throats by greedy Big Pharma, that vaccines contain dangerous chemicals and that childhood illnesses are not as harmful as public-health officials make them out to be. They opt instead for “alternative” treatments and, in most cases, honestly believe they are making the right choice for their children. 

Many of these beliefs are rooted in scientific ignorance, and the fact that it’s much easier to find unabashed nonsense than easily digestible scientific fact in cyberspace certainly facilitates the embrace of quackery. 

At some point, however, we need to ask whether our education system is arming young people with the necessary skills, if they grow up with no understanding of basic biology and a chilling disregard for rational argument.