The November 2, 2012 issue of Morbidity and Mortality Weekly (MMWR) provided annual rates of global immunization coverage during 2011. While global vaccine coverage is not something we might often consider as we try to get children in the United States immunized, it is important to realize how small the globe can be with the ease of international travel. Many countries do not struggle with a complex immunization schedule, but the healthcare providers in those countries might wish they did have such an issue because the truth of the matter is, if they are not struggling with the vaccinations, they are likely struggling with the diseases.
The Global Routine Vaccination Coverage report provides an opportunity to review the data from other immunization programs in other parts of the world:
|Vaccine||Percent of Countries Offering During 2011*||Percent of Vaccine Coverage in Children Throughout the World|
Hepatitis B (3 doses)
Haemophilus influenzae type b (3 doses)
Rotavirus (2 or 3 doses, depending upon formulation used)
Pneumococcus (3 doses)
*Percent countries represents percent of 194 WHO member states offering the vaccine.
If you compare vaccine use around the world with the top causes of childhood mortality, you find that many of the leading causes of death in children could be decreased with an increased use of vaccines. For this reason, programs promoting vaccination in other countries are of the utmost value. And without much of a leap, the potential for those diseases to spread into the United States (e.g., international adoption, business travel, learning-abroad experiences) becomes obvious, necessitating continued vigilance in keeping families in our country – starting with families in our own practices – protected through vaccination.
Each year the Centers for Disease Control and Prevention (CDC) conducts the National Immunization Survey (NIS) to monitor immunization rates throughout the country. Data related to infants and teens are collected via random-digit dialing with a follow-up survey to providers to confirm data accuracy. Data related to kindergarteners are collected from health department reports. All three of these reports were released in recent weeks.
The 2011 survey covered children born between January 2008 and May 2010. Measures of vaccine coverage included at least one dose of MMR and varicella vaccines, at least three doses of hepatitis B and polio vaccines, and at least four doses of DTaP and pneumococcal vaccines. Likewise, full coverage for the Hib vaccine was also measured.
The following is a partial summary of data from 2010 and 2011:
|Vaccine (doses)||2010 (%)||2011 (%)||Relative Change|
|DTaP or similar (≥4)||84.4||84.6||+0.2|
|Hepatitis B (≥3)||91.8||91.1||-0.7|
|Hepatitis A (≥2)||49.7||52.2||+2.5|
|Hib (full series)||66.8||80.4||+13.6|
|Pneumococcal (≥ 4 doses)||83.3||84.4||+1.1|
|Varicella (≥ 1 dose)||90.4||90.8||+0.4|
*Up-to-date (routine coverage) included at least: four doses of DTaP (or similar), three doses of polio, one dose of measles-containing vaccine, full series of Hib (three or four doses depending upon product used), three doses of hepatitis B, one dose of varicella, and four doses of pneumococcal.
To view the entire report or check coverage in your area, see the September 7, 2012 MMWR.
Data reported was for the 2011-12 school year and was collected via departments of health. Vaccines measured included MMR, DTaP (or related), polio, hepatitis B, and one or two doses of varicella. Exemption rates were also reported.
|Vaccine||Median Coverage (%)|
|Varicella||1 dose – 97.0
2 doses – 93.2
*Exemptions increased from 1.1 percent in the 2009-2010 reporting period.
While coverage rates were relatively high, pockets of lower coverage are sources of concern. Access the full report, published in the August 24, 2012 issue of MMWR to see how your state or area compares.
Data collected for the teen survey reflects the immunization coverage for adolescents born between January 1993 and February 1999. Vaccines measured included meningococcus, Tdap, HPV, influenza, hepatitis B and varicella. Below is a partial summary of data from 2010 and 2011 reports:
|Vaccine||2010 (%)||2011 (%)||Relative Change|
|Tdap (or Td)||81.2||85.3||+4.1|
|Tdap (not Td)||68.7||78.2||+9.5|
(series initiation – at least 1 dose)
(series initiation – at least 1 dose)
|HPV females (≥3 doses)||32.0||34.8||+2.8|
(series initiation – at least 1 dose)
|HPV males (of those who started series, % who completed series)||41.6||28.1||- 13.5|
|HPV males (> 3 doses)||n/a||1.3||n/a|
|MMR (≥ 2 doses)||90.5||91.1||+0.6|
*History of disease or two or more doses.
Wide variability by state and vaccine continues to be a concern for public health officials. Access the full report to view data specific to your region in the August 31, 2012 MMWR.
New study does not find correlation between receipt of HPV vaccine and sexual activity
In January 2012, researchers from the Centers for Disease Control and Prevention (CDC) published a study evaluating the relationship between receipt of human papillomavirus (HPV) vaccine and sexual activity (Liddon NC, Leichliter JS, Markowitz, LE. "Human Papillomavirus Vaccine and Sexual Behavior Among Adolescent and Young Women," Am J Prev Med. 2012 Jan;42(1):44-5.
To put this study in perspective, following licensure of HPV vaccine in 2006, several concerns were raised. The media carried stories claiming that HPV vaccine caused chronic fatigue syndrome as well as blood clots with consequent strokes and heart attacks. However, post-licensure studies have exonerated HPV vaccine as a cause of any of these severe adverse reactions. Another question that was raised was whether receipt of HPV vaccine would cause adolescents and young women to increase sexual activity. To answer this question, CDC researchers surveyed 1,243 women between 15 and 24 years of age. Not surprisingly, they found "no association between HPV vaccination and risky sexual behavior."
In truth, the concern about increased sexual activity following vaccination never made much sense. First, no vaccine is 100 percent effective. Second, the HPV vaccine doesn’t prevent all types of HPV. Third, the HPV vaccine doesn’t prevent other sexually transmitted diseases, such as Chlamydia, herpes, gonorrhea, or syphilis. Still, the concern persisted.
The HPV vaccine has been recommended for routine use in 11- to 13-year-old girls for about five years. Unfortunately, uptake has been poor. Only about one-third of those for whom the vaccine is recommended get it. With this latest study, clinicians can offer further reassurance about this much-needed vaccine.
Charlotte A. Moser, Assistant Director, and Paul A. Offit, Director, Vaccine Education Center at The Children’s Hospital of Philadelphia
We often get questions about the use of cell lines from aborted fetuses in vaccines. In this article, we will address the issues and provide information about the resources available to share with parents.
The only vaccines that are made in human cells are:
The viruses were grown in cells obtained from elective terminations of pregnancies which occurred in the early 1960s. Since that time, the cell lines have been maintained in the laboratory. No further sources of fetal cells are necessary.
The questions about use of fetal tissues generally fall into one of three categories:
Christian Science does not believe in using any vaccines; however, when outbreaks have occurred in communities with Christian Scientists, some have agreed to be vaccinated. Their concerns are not related to the use of fetal tissue, but rather to the use of modern medical interventions.
Given the position of the Catholic Church on abortion, some concerns have revolved around the use of cell lines from aborted fetuses. However, reviews by both the Vatican’s Pontifical Academy for Life and the National Catholic Bioethics Center have determined that vaccines grown in these cell lines do not defy the religion’s doctrine:
The concern about DNA is that it can cause changes in the vaccine recipient’s DNA. This is unlikely for two reasons:
The concern about contamination of vaccines with human proteins seems to be relatively new. Because viruses are purified during vaccine production, it is unlikely that proteins from the human cells used to grow them would survive intact or in quantities sufficient to cause harm.
Paul A. Offit, Director, Vaccine Education Center at The Children’s Hospital of Philadelphia , Dec. 2010
Many of today’s consumers crave organic, all-natural, or free-range products. Willing to pay more and drive further to get these products, they believe they are keeping their families healthy. Some of these same people forego vaccines claiming that they are not natural.
According to the Merriam-Webster dictionary, natural means “being in accordance with or determined by nature.” Viruses and bacteria are natural; diseases caused by them are natural.
Because vaccines are made using parts of the viruses and bacteria that cause disease, the ingredient that is the active component of the vaccine that induces immunity is natural. However, critics point to other ingredients in vaccines or the route of administration as being unnatural.
“Green our vaccines” is a common mantra of those who believe that the ingredients in vaccines are harmful—and unnatural. However, vaccine vials contain well-characterized ingredients in known quantities.
Vaccines contain three types of ingredients other than the virus or bacterium of interest:
Some wonder about the amount of different additives in vaccines or the cumulative effect from several vaccines. This is a valid concern; in fact, the Swiss chemist Paracelsus coined the phrase, “the dose makes the poison.” However, the good news is that the quantities of ingredients in vaccines are determined to be the lowest amounts necessary and when vaccines are given together, they must be studied together. So the quantities of ingredients in vaccines have been determined to be safe.
Viruses and bacteria typically enter the body through our noses or mouths. With the exceptions of the oral rotavirus and intranasal influenza vaccines, most vaccines are given as a shot. While at first glance the injections appear to be different or “unnatural,” they are not when you consider what happens in each case.
When viruses or bacteria enter the body through the nose or mouth, they are detected by cells of the immune system which line the surfaces of these areas of entry. These “foreign invaders” are ingested by immune cells and processed in lymph nodes in the region of the infection. The immune response has two aspects, local and systemic. The immune cells are produced near the site of the infection, but they are dispersed throughout the body via the bloodstream. After the infection has been resolved, a small number of immune memory cells continue circulating to monitor for future infections. Because these memory responses are specific, subsequent exposures to the same virus or bacterium generate a quicker and stronger immune response that completely prevents or significantly lessens the effects and duration of illness.
Vaccines are no different. Although common belief is that vaccines are injected directly into the bloodstream, they are actually administered into muscle or the layer of skin below the dermis where immune cells are produced and circulate as occurs following natural infection.
The active ingredients in vaccines are the parts of the viruses or bacteria to which we make an immune response. The additional ingredients are determined to be the lowest plausible quantities and are studied as part of the vaccine during safety testing. The immune system responds in the same way it would to the virus or bacteria following unexpected introduction. So while not natural in that they are given at specified times, vaccines offer a controlled way to protect ourselves from the viruses or bacteria that cause illness.
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