Mark Crislip: The History of Vaccines





We live longer than anytime in history. Our long lives are due in large part to good nutrition, sanitation, and vaccines.

There have been numerous posts here and elsewhere about the vaccine deniers, primarily focused around the modern myth that vaccines cause autism.

That is not the topic of this post. Instead, I am going to take a brief tour of the childhood vaccines and review the morbidity and mortality caused by vaccine preventable diseases and the efficacy of the vaccines in preventing these diseases. With the brouhaha surrounding vaccines it is beneficial to step back and contemplate the death and misery that the vaccine preventable disease have caused and continue to cause.

In the interests of full disclosure, I am an Infectious Disease doctor. I make a living from treating diagnosing and treating infections. I don’t make dime one if people do not get infected, so I am against any and all vaccines as they cut into my bottom line (2).

The scope of these infectious diseases is mind numbing. I do not know how to put all this suffering and death into understandable numbers. Billions of people, primarily children, have suffered and died from these diseases. Before vaccines, most children would suffer the majority of these illness before adulthood. They still do in other parts of the world. If the vaccine deniers had their way, our children could suffer again and millions of more would be added to the list of the dead and maimed.

I have seen almost all the illnesses on this list, except diptheria, which is a function of my specialty. Because of vaccines, many of these diseases are rare in the US, and many physicians will never see many of the diseases on this list during an entire career. Which is good. Watching children needlessly suffer and maybe die is not why we go into health care.

As a last note, I have tried to find similar data but each disease has its numbers collected at different times by different organizations. I have tried to find representative data for each disease.

Hepatitis B

The Disease: hepatitis (liver infection) and chronic hepatitis B causes cirrhosis (fibrosis of the liver with liver failure) and liver cancer.

World Wide disease: 300,000,000 carriers worldwide, it kills 500,000 to 1.5 million per year world wide.

US disease: 5% of the US has the disease. An estimated 800,000–1.4 million persons in the United States have chronic HBV infection (CDC). 3,000-4,000 deaths annually from cirrhosis and 1,000 deaths from hepatoma are HBV.

Vaccine efficacy: >90% after three doses of the vaccine.

In 2001 alone, it is estimated that the vaccine prevented 600,000 deaths. Routine infant hepatitis B vaccination, with 90% coverage and the first dose administered at birth would prevent 84% of global HBV-related deaths (3). that’s around 850,000 people, give or take.

Vaccine Side effects: not autism. “The most frequently reported side effects in persons receiving hepatitis B vaccine are pain at the injection site (3%–29%) and temperature of >99.9°F (>37.7°C) (1%–6%) (CDC). However, in placebo-controlled studies, these side effects were reported no more frequently among persons receiving hepatitis B vaccine than among persons receiving placebo (CDC).

“On the basis of VSD data, the estimated incidence of anaphylaxis among children and adolescents who received hepatitis B vaccine is one case per 1.1 million vaccine doses distributed (95% confidence interval = 0.1–3.9) (CDC)”.

Rotavirus

The Disease: a viral diarrhea that kills children.

World Wide disease: “Each year, rotavirus causes approximately 111 million episodes of gastroenteritis requiring only home care, 25 million clinic visits, 2 million hospitalizations, and 352,000–592,000 deaths (4)”, primarily in those less than age 5.

US disease: 70,000 cases a year, maybe 100 deaths.

Vaccine efficacy: “This vaccine will prevent 74 percent of all rotavirus cases, about 98 percent of severe cases, and about 96 percent of hospitalizations due to rotavirus. (5)”

Vaccine Side effects: Not autism. “Children are slightly (1 to 3 percent) more likely to have mild, temporary diarrhea or vomiting within 7 days after getting a dose of rotavirus vaccine than children who have not gotten the vaccine.(6)”

Diphtheria

The Disease: a bacterial sore throat that kills by obstructing the airway or by making a toxin that affects the heart and the central nervous system.

The historical disease: In the 1920s there were 100,000 to 200,000 cases of diphtheria per year in the United States, with 13,000 to 15,000 deaths.

World Wide disease: in 2002, 4,000 children died from diphtheria, from 1990 to 95 there was an epidemic in the old states of the USSR with approximately 125,000 cases and 4000 deaths (7).

US disease: rare, with less than one case a year.

Vaccine efficacy: >95% effective in preventing diptheria.

Vaccine Side effects: not autism. Local reactions and fevers.

Tetanus

The Disease: Lockjaw. Severe, uncontrollable, painful spasms of every muscle in your body followed by cardiovascular collapse.

The historical disease: 600 cases and 180 deaths each year in U.S. More than 500,000 deaths per year worldwide.

Death: 1 in 3.

World Wide disease: in 2002, 198,000 children died from tetanus out of about a million cases.

Vaccine efficacy: Unknown from clinical trials, but the series of three gives levels of neutralizing antibody that suggests 100% efficacy and cases are rare in the vaccinated.
In 2002 it is estimated that the vaccine saved 643,000 lives world wide (8).

Vaccine Side effects. Not autism. Mostly local symptoms and rarely severe allergic reactions (1 in a million).

Pertussis

The Disease: Whooping cough. An infection of the throat due to Bordetella pertussis that leads to obstruction of the airway.

World Wide disease: in 2002, 294,000 children died from pertussis.

US disease: “The rate of pertussis peaked in the 1930s, with 265,269 cases and 7518 deaths reported in the United States. This rate decreased to a low in 1976, when 1010 cases and 4 deaths occurred (9)”. Before the vaccine pertussis killed about 8000 children a year.

Death: 1 in 500 (10).

Vaccine efficacy: Vaccine efficacy is 64%, 81%, and 95% for case definitions of mild cough, paroxysmal cough, and severe clinical illness, respectively (11).

Vaccine Side effects. Not autism. Certainly the most problematic of the vaccines. Besides local reactions, there is :”acute encephalopathy. This adverse event occurs rarely, with an estimated risk of zero to 10.5 episodes per million DTP vaccinations (12)”.

Hemophilus influenzae type b

The Disease: sepsis and meningitis.

The historical disease: Before vaccine Hib was the leading cause of bacterial meningitis (1 in 200) among children under 5 years of age in the United States. 20,000 children in the US under age 5 got severe Hib disease each year and 1,000 died.

World Wide disease: three million serious illnesses and an estimated 386 000 deaths per year (13).

Death: 1 in 20 children with invasive Hib disease.

Vaccine efficacy: 95%.

Vaccine Side effects: not autism. No serious events.

Pneumococcus

The Disease: sepsis and meningitis.

World Wide disease: An estimated 700,000 to one million children die of pneumococcal disease every year (14).

US disease: before the vaccine, 700 cases of meningitis, 13,000 bacteremias and 200 deaths.

Vaccine efficacy: It is more than 90% effective against
invasive disease.

Vaccine Side effects: not autism. No serious side effects.

Poliovirus

The Disease: polio.

The historical disease: 38,000 cases per year in the US prior to vaccine, including 21,000 cases with paralysis.
1400 deaths a year.
Permanent paralysis: 1 in 100
Death: 1 in 20 children and 1 in 4 adults with paralytic polio.

World Wide disease: 1900 cases a year; in countries that have stopped vaccines there have been outbreaks.

Vaccine efficacy: 99%.

Vaccine Side effects: not autism. No serious adverse reactions.

Measles

The Disease: measles.

The historical disease: 400,00 cases a year in the US with 400 deaths.

World Wide disease: Measles infects 25 to 30 million children each year and kills 345,000 (15).

Vaccine efficacy: 90-95%.

Vaccine Side effects: not autism, allergic reaction in 1 in a million.

Mumps

The Disease: mumps.

The historical disease: in the US, 200,000 per year before vaccine with
Encephalitis: 2 in 100,000
Testicular swelling: 1 in 5 adults
Deafness: 1 in 20,000
Death: 1 in 3,000 to 1 in 10,000.

World Wide disease: 13,000 cases a year currently.

Vaccine efficacy: 90-98%.

Vaccine Side effects: not autism, less than 1 in a million will have a severe allergic reaction.

Rubella

The Disease: German measles

The historical disease: in US 12.5 million cases in 1964-65, including 2,100 infant deaths, 11,250 fetal deaths, and 20,000 newborns born with congenital rubella syndrome (deafness, cataracts, mental retardation).

Death: 1 in 3,000 to 1 in 10,000.

World Wide disease: in 2001, 836,000 cases with 100,000 cases of congenital rubella syndrome (16).

Vaccine efficacy: > 95%.

Vaccine Side effects: not autism, less than 1 in a million will have a severe allergic reaction.

Varicella

The Disease: chicken pox.

The historical disease: 4 million cases a year in the US before the vaccine with 100 deaths.

World Wide disease: can not find a reference, not even at WHO. Must run into the tens of millions.

Vaccine efficacy: 99%.

Vaccine Side effects: not autism.

Hepatitis A

The Disease: hepatitis.

The historical disease: 125,000-200,000 cases in U.S. each year before the vaccine.
Deaths: 70-100 per year in U.S.

World Wide disease: 1.5 million clinical cases a year, many more subclinical.

US disease: 30,000 cases (3000 symptomatic).

Vaccine efficacy: 99%.

Vaccine Side effects: not autism. No serious reactions.

Meningococcus

The Disease: sepsis and meningitis.

World Wide disease: outbreaks in Africa have 250 000 cases and 25 000 deaths (17).

US disease: 2,500 people are infected and 300 die in the US (18).

Vaccine efficacy: 85%.

Vaccine Side effects: not autism. No serious side effects.

Summary:

Vaccines have prevented millions of deaths and even more suffering with almost no complications.

To quote a JAMA review that looked at the effect of vaccines on morbidity and mortality (19).

“A greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus. Endemic transmission of poliovirus and measles and rubella viruses has been eliminated in the United States; smallpox has been eradicated worldwide. Declines were 80% or greater for cases and deaths of most vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, Hib, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively.”

The impact of vaccines on improving the health and well being of mankind has been tremendous. In the US we have lost track of the benefits as we have not had to see our children suffer and die from these diseases. We also have lost track of how quickly infectious diseases can spread and kill. Influenza, without the benefit of modern transportation, managed to kill 25 to 50 million people in 1919. Estimates suggest that these diseases may have helped killed 90 plus percent of the indigenous peoples of North and South America when introduced by Europeans.

The key word of my speciality is infectious. Many of these illnesses, besides being preventable, are highly and efficiently contagious. With the exception of smallpox, all these infections continue to exist and outbreaks continue to occur in populations that, for whatever reason, fail to get vaccinated. Measles, pertussis, polio and others continue to return to kill and injure, always in the unvaccinated.

The amazing feature of vaccines is how much benefit they provide for so little risk and so little cost. Most of the time, especially in acute care medicine, you have to continually weigh the risks of therapies or procedures against the potential benefit. And everything costs so much money. Vaccines are almost a free lunch.

Green our vaccines? The only green you will see by getting rid of vaccines or decreasing their use is the grass growing on the graves of children needlessly killed by preventable infections.

______________________________
1- I would not have used the term parasites, however, to characterize parents who do not vaccinate their children. Freeloaders? Sponges? Ignorant? Uninformed? Dumb as a box of rocks? Incompetent? Child abusers?
2- Sarcasm.
3- http://ije.oxfordjournals.org/cgi/content/abstract/34/6/1329
4- http://www.cdc.gov/ncidod/EID/vol9no5/02-0562.htm
5- http://www.cdc.gov/vaccines/vpd-vac/rotavirus/
6- http://www.cdc.gov/vaccines/vac-gen/side-effects.htm#rota
7- http://www.cdc.gov/mmwr/preview/mmwrhtml/00043378.htm
8- http://www.dcp2.org/slides/269/preview
9- http://www.emedicine.com/emerg/byname/Pediatrics–Pertussis.htm
10- http://www.metrokc.gov/health/immunization/compare.htm
11- http://jama.ama-assn.org/cgi/content/abstract/267/20/2745
12- http://www.cdc.gov/mmwr/preview/mmwrhtml/00046738.htm
13- http://www.who.int/mediacentre/factsheets/fs294/en/
14- http://www.who.int/nuvi/pneumococcus/en/
15- http://www.unicef.org/immunization/index_measles.html
16- www.who.int/immunization_monitoring/rub_global_review_2003.pdf
17- http://www.who.int/mediacentre/factsheets/fs141/en/
18- http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm
19- http://jama.ama-assn.org/cgi/content/full/298/18/2155



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More Comments:


Jonathan Dresner - 8/20/2008

The CDC, like any responsible scientific institution, makes note of new research as necessary. The research you call for on the unvaccinated has, in fact, been done, but the results don't support your anti-vaccine ideas.

And nothing in the above post suggests that vaccine related injuries don't occur -- though having two people in a family experience significant negative results is a statistical stretch, to be sure.

If you do the math, it's quite clear that the real benefits of the vaccines listed far outweigh the real harm.


Dawn Crim - 8/18/2008

Mark: All I have to say is that you are either an idiot or a big fat liar. My baby and I were injured by vaccines just last year. You doctors disgust me. Are you aware that the CDC is constanting altering the "facts" when it comes to vaccines and disease statistics? Why don't you ask these government organizations why they are not having Congress support a bill to study the unvaccinated/vaccinated at the moment? That would speak volumes. Please stop speaking of topics you obviously know nothing about.