S UFFER THE L ITTLE C HILDREN : T HE RE - EMERGENCE OF V ACCINE - P - - PowerPoint PPT Presentation
Global Problems, Global Solutions Global Problems, Global Solutions S UFFER THE L ITTLE C HILDREN : T HE RE - EMERGENCE OF V ACCINE - P REVENTABLE D ISEASE Carol H. Gilmour, MD, MPH, FAAP Newborn Medicine Program, UPMC Babys Death
100/1000 LB (1900) (1900)
6.1/1000 LB (2010) (2010)
Example: Measles-containing vaccine effectiveness
93% after 1 dose dose
97% after 2 doses doses
OPV OPV, S Sudan (WHO photo) dan (WHO photo) Polio sur lio survivors, Nigeria ivors, Nigeria
Caption: “ n: “The outrag he outrageous eous manner in which our manner in which our school school children are to have deadly children are to have deadly micr microbes [??] their syst
Let Mayor Stuart forbid it at once.” Mayor Stuart forbid it at once.”
Sund nday Item ay Item, 1 , 1894, 94, Philadelphi Philadelphia
70% US children age 19-35
months were immunized as per months were immunized as per
ACIP/ ACIP/AAP/A AP/AAFP/ AFP/ACOG (2013) ACOG (2013)
0-7% non-medical exemp emptions ions
Libertarian (autonomy), R utonomy), Religious ligious
Infants
egnant women
Immunocompr mpromised mised
10 deaths in 2010 in 2010
28,000 cases in 2014 2014
ssive infant immunity
Cocooning
Highly contagious
Coughing, ng, sneezing sneezing
Direct contact with secretions
4 days before – days before – 4 days after rash days after rash
Incubation period
7-21 days after exposure posure
Clinical presentation
High fever (105⁰ F) x 4-7 days F) x 4-7 days
Malaise
Cough, coryza, conjunctivitis za, conjunctivitis
Enanthema (Koplik Koplik spots) spots)
Exanthem em (morbilliform (morbilliform rash) rash)
Olivia, my eldes Olivia, my eldest daughter daughter, caught measle , caught measles when she was seven years when she was seven years
urse I can remember reading to her
bed and not feeling particul not feeling particularly alarmed about it. Then one arly alarmed about it. Then one morning, when she was well on the r morning, when she was well on the road to recove ad to recovery, I was sitting on , I was sitting on her bed showing her how to fashion little animals out of her bed showing her how to fashion little animals out of coloured coloured pipe-cleaners, pipe-cleaners, and and when it came to her turn to mak when it came to her turn to make one herself
I noticed that her fingers and her m noticed that her fingers and her mind were not working together and ind were not working together and she couldn’t do anything. she couldn’t do anything. “Are you feeling all right?’ re you feeling all right?’ I I ask asked her d her. “I feel all sleepy “I feel all sleepy,’ she said. ,’ she said. In an hour In an hour, she was unconscious. , she was unconscious. In twelve hours she was dead. In twelve hours she was dead.
ald Dahl, 1986
Measles elimination is define defined as the absence of endemic d as the absence of endemic measles virus t asles virus transmission in ansmission in a a de defined g fined geographical are raphical area (e.g. (e.g. region or countr region or country) for y) for ≥12 months in 12 months in the presence of the presence of a a well- well- perform performing sur ng surveill eillanc ance syste system
west cases = 3 ses = 37 (2004) (2004)
Most cases = 644 (2014)
23 Outbreaks
Ohio Amish, 383 cases
015 (as of 3/27) 27)
4 Outbreaks
amusement sement park, park, 146 cases 146 cases
Likely ly fr from
traveler er overs
as
Unvaccinat inated ed
Breastfeeding
alorie
Micronutri utrients ents
tamin A, n A, Vitamin D, tamin D, Zinc, Seleniu Zinc, Selenium
Cost effective: direct and societal and societal
Bill and Melinda Gates Melinda Gates Fo Foundation
rld Health Organization (WHO (WHO)
UNICEF
National Institute of Allergy and Infectious Disease Infectious Diseases (NIAID) (NIAID)
Coordination of international international vaccine community vaccine community
Global Vaccine ccine A Action Plan tion Plan
Discovery
Development
Delivery
save >20M lives, prevent prevent ~1Billion illnesses by 2020-saving ~1Billion illnesses by 2020-saving nearly $12 billion in nearly $12 billion in treatment treatment costs, achieve >$800 billion in costs, achieve >$800 billion in economi economic gains gains as vaccinated as vaccinated children live longer children live longer, healthier , healthier, more pr more producti
ve lives
rst Global Vaccine Summit, ccine Summit, April 2013 in April 2013 in Abu Dhabi Abu Dhabi
Annual observance to vance to pr promote the be
nefits of childhood immunizations and their r and their role in impr le in improving th
e health of children aged children aged ≤2 years 2 years
CDC's new Born with P Born with Protection
campaign, to pr promote whooping cough
vaccinatio vaccination during the third trimester n during the third trimester of
each pregnan nancy to help pr y to help protect
babies during their first few months of babies during their first few months of life when they are most vulnerable life when they are most vulnerable
MMWR W MMWR Week ekly ly April 10 ril 10, , 2015 15 / / 64(13);357-362 (13);357-362
Disease Name(s) Etiology First disease Rubeola, Measles, 14-day measles Measles virus Second disease Scarlet Fever, Scarlatina Streptococcus pyogenes Third disease Rubella, German measles, 3-day measles Rubella virus Fourth disease Filatow-Dukes’ Disease, Staph Scalded Skin? XXX, Staphylococcus aureus Fifth disease Erythema infectiosum Parvovirus B19 Sixth disease Exanthem subitum, Roseola infantum, 3-day fever Human Herpes Virus 6B or Human Herpes Virus 7 * Other causes of widespread rash and fever: CMV, Epstein-Barr virus, Enterovirus, Adenovirus, Group C Strep, Varicella zoster
In 1845, when I was ten years old, there was an epidemic of measles in the town and it made a most alarming slaughter among the little
were nearly demented with fright. I grew very tired of the suspense I suffered on account of being continually under the threat of death….I made up my mind to end this suspense and be done with it. Will Bowen was dangerously ill with the measles and I thought I would go down there and catch them…. It was a good case of measles that resulted. It brought me within a shade of death’s door….The word had been passed and the family notified to assemble around the bed and see me off.
wain
Patients in ir tients in iron lungs, 1
952, Los Angeles, Ca s Angeles, California lifornia
Disease Pre-vaccine 2000 % Change Diphtheria 31,054 1
Measles 391,852 86
Mumps 21,342 338
Pertussis 117,998 7,867
Polio (wild) 4,953
Rubella 9,941 176
Congenital Rubella syndrome 19,177 9
Tetanus 1,314 35
I nvasive Hib disease 24,856 112
Total 566,706 8,624
Adverse events reported after va verse events reported after vaccines against these diseases: 5,296 ccines against these diseases: 5,296
Disease I mmunity Threshold Mumps 75-86 Polio 80-86 Smallpox 80-85 Diphtheria 85 Rubella 83-85 Pertussis 92-94 Measles 83-94