Vaccines

Vaccination in TexasVaccinations -- Guarding all of usProtecting our Economy

Advances in Public Health in 20th CenturyModern Water SanitationVaccinationsMotor Vehicle SafetyTobacco Hazard AwarenessSafer FoodsSafer Work EnvironmentsFamily PlanningHealthier Moms and Babies

How Vaccines WorkPersonal ImmunityDevelop antibodies to a component of the diseaseAntibodies prevent disease if exposed

Herd ImmunityPrevents significant transmission of contagious diseasesActs as a firewallProtection extended to unvaccinated individuals (e.g. very young or immunocompromised)Threshold level of vaccine coverage to be effectiveVaccination:A public and private partnershipA responsibility over the lifespanOne of the most cost effective ways to protect Texans and the Texas economyComparison of Cases and Deaths for Vaccine-Preventable DiseasesDiseasePre-vaccine Annual CasesPre-vaccine Annual DeathsPeak CasesPeak DeathsRecent Cases2006Recent Deaths2004% Reduction Cases% Reduction DeathsDiphtheria21,0531,82230,5083,06500100100Measles530,217440763,09455255099.9100Mumps162,34439212,932506584095.9100Pertussis200,7524,034265,2697,51815,6322792.299.3Polio, paralytic16,3161,87921,2693,14500100100Rubella47,745174,88,7962411099.9100Congenital Rubella152n/a20,0002,16010151n/aSmallpox29,00533711,06722,51000100100Tetanus58047260151141492.999.2Source: JAMAVaccines Licensed before 1980Vaccines Licensed 1980 2005 DiseasePre-vaccine Annual CasesPre-vaccine Annual DeathsPeak CasesPeak DeathsRecent Cases2006Recent Deaths2006% Reduction Cases% Reduction DeathsHepatitis A117,333137254,51829815,298188786.9Acute Hepatitis B66,23223774,36126713,1694780.180.2Invasive Hib20,0001000n/an/a99.5Invasive pneumo-coccal63,0676,50064,400730041,5504,85034.125.4Varicella4,085,1201055,358,595138612,768198581.9Comparison of Cases and Deaths for Vaccine-Preventable DiseasesSource: JAMADiphtheria 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 DeathMeasles 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

CDC, MMWR, Measles --- United States, January--May 20, 2011, May 27, 2011 / 60(20);666-668.From 2001--2008, a median of 56 (range: 37--140) measles cases were reported to CDC annually; 118 measles cases were reported during the first 19 weeks of 2011 the highest # reported for the same period since 1996. 89% were likely associated with exposure in other countries. As of October 2011, there were more than 200 cases reported in the U.S. (World Health Organization), the highest number since 1996. WHO reports that in 2011 there were more than 26,000 measles cases in Europe alone.8For every $1 spent on: Vaccine Economic SavingsDTaP $27.00 MMR $26.00 Perinatal Hep B $14.70Inactivated Polio (IPV) $5.45H. Influenza type b$5.40 Varicella$5.40Source: adapted from: http://www.ecbt.org/advocates/economicvaluevaccines.cfm#_edn19A communicable disease outbreak has economic costs2008 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.San Diego Outbreak CostsThe states 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.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

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 1Preventable Hospitalization CostsAverage costs of child hospital stay, pertussis $5,200Source: AHRQ

Average costs of adult hospital stay, bacterial pneumonia $29,295Source: DSHSEstimated 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.$99,280 represents crude estimate of total annual costs for all households reporting a case(s) of pertussis in 2009Based on responses from 104 households with at least one confirmed or probable case of pertussis with an onset of symptoms date in 2009.Does not factor in costs of unreported cases Does not factor in costs of pertussis related hospital admissionsSchool & Daycare Days Missed estimated at 2,125 Work Days Lost estimated at 1,440 15Paralytic Polio Most affected people without obvious symptoms 1% of cases progress to paralysis Spread person to person via fecal-oral route Nearly eradicated in 1990s Resurgence of disease in Nigeria, Afghanistan, India and Pakistan

HiB Disease20000 affected children per year pre-vaccineMeningitisEpiglottitisSevere disabilityVirtually eliminated with vaccine

Invasive HiB Story

InfluenzaMillions of cases annually20000 children hospitalized each year50-150 children die each yearVaccine very effective but is victim of misinformation and misunderstanding

Meningococcal Disease

MeningitisMeningococcemiaPoorly recognized in early stagesHigh feverBody achesRashDisability and deathMeningococcal Disease Story

Vaccine Economics - Comparing Physician Costs to Selling Ice Cream

Ice Cream and Vaccines

SimilaritiesAcquisition cost is variablePerishable with defined shelf lifeMaintenance costsProvision costsLiability for lossIce Cream and Vaccines - Acquisition CostProduct Cost DifferencesSingle SourcePrevnar 13, Ipol, Gardisil, FlumistPistachio Almond, Love Potion #31Multiple SourceDtap, Hib, Tdap, Hep BVanilla, Chocolate, Strawberry

Ice Cream and Vaccines

DifferencesUnit cost (financial risk)Sales tax, vs. excise tax + franchise taxPayment termsIce cream vs. I screamIce Cream and Vaccines - Provision CostsIce cream - Napkins, cups, cones, spoons, tables, chairs, sprinkles, scoops

Vaccines - Syringes, needles, alcohol pads, bandages, 7 feet of table paper, examination tableIce Cream and Vaccines

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.The Anti-Vaccine PhenomenonIf 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 KingDr. Oz, Dr. BobThe Anti-Vaccine PhenomenonThe trouble with the world is not that people know too little, its that they know so many things that just arent so.Mark Twain

Pockets of vulnerability

Return of vaccine-preventable diseasesMeasles, HiB disease, pertussis

Source: The Wall Street Journal, Where Could The Next Outbreak Of Measles Be? March 20, 2012, http://online.wsj.com/article/SB10001424052702303863404577284001227981464.html. 31Why Bother?Providing vaccines to a patient is the only medical service provided to an individual that benefits the rest of society