Put to death

The science writer Carl Zimmer addressed the question of whether our stocks of smallpox should be destroyed back in 2011, the last time this decision was made. The decision will be back up for discussion again in 2014 I think.
Should Smallpox Be Put To Death?

 Should the virus be preserved so that it can be studied? Or should the virus be destroyed, so that—in theory at least—it would become extinct and would not threaten the human species again?

For a lengthier discussion see Smallpox Virus Destruction and the Implications of a New Vaccine  by D.A. Henderson, one of the people behind the eradication of smallpox.

Public service announcement

A repeat from 2011 but consider this a public service announcement.

Regardless of what you may have heard about chlamydia it's actually HPV, Human Papillomavirus Virus, that is the most common sexually transmitted infection in the US. One of the reasons for this is that in many cases the infected person has no signs or symptoms. Because of this the CDC estimate that by the age of 50 more than 80% of American women will have contracted at least one strain of genital HPV.

Whoa. Screechy noise. Backup.  By the age of 50 more than 80% of American women will have contracted at least one strain of genital HPV.

Although only a small percentage of these women will develop cervical cancer the fact that such large numbers of women are infected each year means that up to 1 million American women are diagnosed with cervical dysplasia each year. Cervical dysplasia, caused by HPV, is a precursor to cervical cancer and is painful and costly to treat. Of these 1 million cases each year about 11,000 subsequently develop cervical cancer and about 4,000 of these women will die. Every year.

So a safe and effective vaccine is going to be a great discovery right?

Widespread vaccination has the potential to reduce cervical cancer deaths around the world by as much as two-thirds, if all women were to take the vaccine and if protection turns out to be long-term. In addition, the vaccines can reduce the need for medical care, biopsies, and invasive procedures associated with the follow-up from abnormal Pap tests, thus helping to reduce health care costs and anxieties related to abnormal Pap tests and follow-up procedures.

—American National Cancer Institute

Because so many women are infected it is clear that women need to be vaccinated before they can become infected. The best way to do this is to vaccinate them before they become sexually active .

Oh oh. We used the sex word.

 

 

Wait, am I missing something here? We leave it up to private companies to develop vaccines and then we find it somehow sinister if they push for mandatory vaccinations when they develop an effective vaccine against a disease that kills thousands. Oh and did I mention that it is estimated (by the CDC) that at any one time 1% of sexually active adults have genital warts (also caused by HPV).

Don't make me post the genital wart pictures....

The Cow-Pock

As I mentioned in class, objectors to vaccination have been around for a long time.

In this famous cartoon from 1802, the British satirist James Gillray caricatured a scene at the Smallpox and Inoculation Hospital at St. Pancras, showing Edward Jenner administering cowpox vaccine to frightened young women, and cows emerging from different parts of people's bodies. The cartoon was inspired by the controversy over inoculating against the dreaded disease, smallpox. The inoculation agent, cowpox vaccine, was rumored to have the ability to sprout cow-like appendages. 

This is undoubtedly due to the fact that vaccination was invented prior to any understanding of immunology or even a germ theory of disease.

AMA and MMR

If you'd like to read more about the MMR-Autism issue then the American Medical Association has a fairly in depth page on its Pediatric Vaccination website: The relationship between the MMR vaccine and autism.

A couple of aspects you may find interesting:

About 90 percent of children in England received MMR at the time this paper was written. Because MMR is administered at a time when many children are diagnosed with autism, it would be expected that most children with autism would have received an MMR vaccine, and that many would have received the vaccine recently. The observation that some children with autism recently received MMR is, therefore, expected. 
...

Perhaps the best data examining when symptoms of autism are first evident are the "home-movie studies". These studies took advantage of the fact that many parents take movies of their children during their first birthday (before they have received the MMR vaccine). Home movies from children who were eventually diagnosed with autism and those who were not diagnosed with autism were shown to blinded eurodevelopmental specialists. Investigators were, with a very high degree of accuracy, able to separate autistic from non-autistic children at one year of age.

These studies found that subtle symptoms of autism are present earlier than some parents had suspected, and that receipt of the MMR vaccine did not precede the first symptoms of autism.

Scare stories and gutter press

It's a sad, but true, fact that it is a lot easier to scare people than it is to unscare them. Certain newspapers love to scare people with any anecdotal association they can dig up.The picture to the left is from Britain's Daily Mail.

The Daily Mail has been campaigning against the HPV vaccine for some while. But they have a right to that opinion. Except it turns out they don't even have that opinion. On the other side of the Irish Sea the Irish edition of the SAME NEWSPAPER is campaigning FOR the HPV vaccine.

From Martin Robbins at Layscience.com:


“Are they insane?! They’re printing scare stores about the dangers of the HPV vaccine in one country, while simultaneously campaigning for its introduction in another. It’s so absurdly cynical that I can’t quite form the words to convey just how shocked I am by this. Even by the piss-poor journalistic standards of the Daily Mail, this takes quite some beating.

What this means is that those of us who believed that the Daily Mail had some editorial, ideological stance against certain vaccines (such as MMR) were in fact wrong. The Daily Mail position on vaccines is whatever sells newspapers – and if those positions are completely self-contradictory, or might cause a bit more cancer in the readership, then who cares, as long as the advertisers are happy?

In many ways, this is worse than being anti-vaccine. Anti-vaccinationists may be cranks, but at least they ultimately care about the people affected. The revelation that the Mail is pushing two contradictory positions on a major public health issue on either side of the Irish Sea, proves once and for all that they don’t give a crap about the impact such stories may have on their readers. It’s a whole new level of sick. It’s crossing the line where misguided becomes truly evil.”

When is a vaccine not a vaccine?

I posted last year about the CIA's use of a fake vaccination campaign in an attempt to verify the identity of Osama bin Laden. A very bizarre story.

In the months before Osama bin Laden was killed, the Central Intelligence Agency ran a phony vaccination program in Abbottabad, Pakistan, as a ruse to obtain DNA evidence from members of Bin Laden’s family thought to be holed up in an expansive compound there, according to an American official. 

One of the oddest parts about this story is that they didn't use the correct vaccination schedule.  They gave inadequate doses of the vaccine, leaving behind kids whose parents thought they were protected from Hepatitis B, but who were, in fact, not.

This year the Taliban have banned a Polio vaccination campaign in Pakistan in protest against both drone strikes and also from fear that the campaign could be used for further CIA espionage activities. Until last year this would have sounded a little paranoid...

Not vaccinated? Not acceptable

To whet your appetite for tomorrow's lecture here is an editorial from the LA times last year

Public health: Not vaccinated? Not acceptable
What should we do about people who decline vaccination for themselves or their children and put the public at risk by fueling the resurgence of nearly eradicated diseases?

What does society do when one person's behavior puts the greater community at risk? We make them stop. We pass laws, or impose economic rules or find some other way to discourage individual behaviors that threaten the greater common good. You don't get to drive drunk. You don't get to smoke in public places. You don't even get to leave your house if you catch some particularly infectious disease.

Then what should we do about people who decline vaccination for themselves or their children and put the public at risk by fueling the resurgence of nearly eradicated diseases? Isn't this the same thing: one person's perception of risk producing behaviors that put others at risk? Of course it is. Isn't it time for society to say we need to regulate the risk created by the fear of vaccines? Yes, it is.

Vaccination then and now

As I mentioned in an earlier class vaccines become victims of their own success. As the diseases they cause become rare and fade from our memory we tend to focus on the possible side effects of the vaccine - sometimes real, sometimes imagined.

However when the actual disease in in your neighborhood, crippling and paralyzing children then you queue around the block to get your child their vaccination shot.

One fact I didn't mention in lecture was that neither Jonas Salk nor Albert Sabin (who invented the oral polio vaccine) patented their vaccines - they donated the rights as gifts to humanity. In fact there's a fairly famous story about Jonas Salk, who worked at the University of Pittsburgh, being asked by a reporter “Who owns your polio vaccine?” On hearing the question, Dr. Salk looked at the reporter and said “Who owns my polio vaccine? The people! Could you patent the sun?”

Vaccine efficacy

Fear of vaccination is nothing new. This famous cartoon by James Gillray is from 1802 and refers to the fears people had against being vaccinated by Cowpox, which was used to give protection to the far more deadly smallpox.


Today the internet gives a voice to everyone. But you need to be critical of what you read. Here's a popular argument against vaccines you'll find. I copied this verbatim from an anti-vaccine website.


Meanwhile, in the real world vaccines are failing miserably. A recent outbreak of mumps in the New Jersey / New York area occurred almost entirely among children who had already been vaccinated against mumps. Clearly if vaccines really worked, then an outbreak should have only occurred among those who were NOT vaccinated against mumps, right? But as I reported, 77 percent of the children who got infected had already been vaccinated!

Sounds convincing? Can you work out what's going on?

Let's consider the numbers. Imagine we have a vaccination rate of 90%. Now, most vaccines only have a certain efficacy, in some cases they just don't work. Let's imagine our mumps vaccine has an efficacy of, say 80%. If you get the vaccine you have an 80% chance of getting immunity, and a 20% chance that you won't. (Which is why we actually need a vaccine coverage in excess of that predicted from R0 in order to establish herd immunity).

So in a population of 100 children we have 10 children who have not been vaccinated and are susceptible. But we also have 20% of the 90 vaccinated children who are susceptible, that's 18.


Assuming our outbreak hits these two groups equally then 18 out of every 28 of those infected (65%) will have been vaccinated. This is an argument for MORE vaccination to protect the fragile herd immunity and for MORE research to increase the efficacy of our vaccines. One of the reasons vaccines are given to children, (apart from giving them protection!) is that their efficacy is usually greatest. I believe this is the case with the HPV vaccines I mentioned. You can get it later in life but there is a greater chance it will not lead  to immunity.

The head and the heart

I just discovered Missouri Medicine - an award winning publication from the Missouri Medicine Association. As a person with some science background but no medical training I find their articles pitched at just the right level.

There's a nice article in the current issue advising doctors how to respond to parents fears of vaccinations.

We in the medical community must acknowledge that, for parents, the idea of allowing their child to be
injected with an agent that might cause harm and will definitely cause pain is, at the very least, unsettling to even the most educated, most rational parent. The genius of the anti-vaccine forces is that they are passionately empathetic toward parents who want only to protect their kids – and they are not shy about the sacrifices that they have personally made in standing up to uncaring physicians and greedy pharmaceutical companies. And how do we respond? Often with a well reasoned, evidence-based argument that dismisses vaccination concerns as unfounded and uninformed.


If we do express emotion about vaccination, it often comes across as either as anger at parents who just do not care enough to do what is best for their children or annoyance on our part for having to waste our time with such nonsense.


The science is clearly, unequivocally, powerfully on our side when it comes to the safety and effectiveness of vaccination, and we must share this information which is at the core of our efforts to prevent disease in children. But we have to remember that parents make decisions about their kids, not from the head, but from the heart.

Researchers believe they may be a step closer to HIV vaccine

Researchers are hoping they are one step closer to a HIV vaccine – using HIV. At the 6th International AIDS Society Conference on HIV Pathogens, Treatment, and Prevention in Rome, researchers with the Maryland-based VirxSys Corporation announced the findings of their VRX1273 vaccine.

The vaccine is a genetically altered version of SIV, the version of HIV found in non-human primates. Over the course of six months, five infected monkeys were injected with the vaccine three times, while five others were given a placebo vaccine. After 18 months, it was found that 40% of the vaccinated monkeys had very low to undetectable amounts of virus in their bodies.

Did the CIA Fake a Vaccination Campaign?

Apparently the CIA faked a vaccination campaign in an attempt to collect DNA samples from Bin Laden's children. The scheme was concocted by the C.I.A. earlier this year when they were struggling to learn whether Bin Laden was hiding in the compound in Pakistan.

There's a fairly factual report in the New York Times, Vaccination Ruse Used in Pursuit of Bin Laden, but they miss the serious implications of this that are discussed in this post at Wired, File Under WTF: Did the CIA Fake a Vaccination Campaign?

This is awful. It plays, so precisely that it might have been scripted, into the most paranoid conspiracy theories about vaccines: that they are pointless, poisonous, covert shields for nefarious government agendas meant to do children harm.

The fallout from this scheme has already begun, Reported CIA vaccine ruse sparks fear in Pakistan.

One of the Pakistani Taliban's top commanders, Maulvi Faqir Mohammed, recently called on people in the northwest to avoid vaccines offered by the international community, claiming they were made with "extracts from bones and fat of an animal prohibited by God — the pig."

"Don't fall prey to these infidel NGOs and this U.S.-allied government and its army," said Mohammed over the illegal radio station he transmits from his sanctuary in eastern Afghanistan.

Pakistani officials and their international partners have pushed back against these claims, but the CIA's reported activities in the country may have made their job that much harder. 

New TB Vaccine

The current Tb vaccine, the BCG vaccine, has been in use since 1921 and there are concerns that its protection may wear off over time - ie the protection given by the vaccine is not lifelong.

A new vaccine, with the catchy name MVA85A has recently passed clinical trials but, unfortunately it doesn't seem to work as well when given with other vaccines:

MVA85A was deemed to be safe, well tolerated and induced a strong immune response. And importantly, the responses to the standard childhood vaccines were not affected by giving MVA85A at the same time. But the immune response prompted by MVA85A was lower in infants who received it with standard childhood vaccines, compared with those who got it alone.
 
"It's reassuring to see that MVA85A does not affect immunity to the other vaccines," said Helen McShane of Oxford University, who helped develop the new shot. But she said scientists would now need to find the best way to integrate MVA85A into infant immunization plans in future without limiting its effect.

Report,  New TB Vaccine Passes Safety Tests, But proves less effective when given with other immunizations at Voice of America.

The Panic Virus

I was going to blog about the release of a new book called 'The Panic Virus' - that has received some good reviews when I noticed that today's Doonesbury cartoon also takes on the Jenny McCarthy issue. As a former playmate Boopsie has some harsh words for Jenny and the damage she has caused to the playmate brand. The full strip is here at Slate.com.

From the blurb for The Panic Virus:

In 1998 Andrew Wakefield, a British gastroenterologist with a history of self-promotion, published a paper with a shocking allegation: the measles-mumps-rubella vaccine might cause autism. The media seized hold of the story and, in the process, helped to launch one of the most devastating health scares ever. In the years to come Wakefield would be revealed as a profiteer in league with class-action lawyers, and he would eventually lose his medical license. Meanwhile one study after another failed to find any link between childhood vaccines and autism.

Yet the myth that vaccines somehow cause developmental disorders lives on. Despite the lack of corroborating evidence, it has been popularized by media personalities such as Oprah Winfrey and Jenny McCarthy and legitimized by journalists who claim that they are just being fair to “both sides” of an issue about which there is little debate. Meanwhile millions of dollars have been diverted from potential breakthroughs in autism research, families have spent their savings on ineffective “miracle cures,” and declining vaccination rates have led to outbreaks of deadly illnesses like Hib, measles, and whooping cough. Most tragic of all is the increasing number of children dying from vaccine-preventable diseases.

Routine HPV vaccine for boys

The American Academy of Pediatrics issued their new immunization schedule recommendations today. It makes sense to keep these regularly updated in response to changing threats (eg the recent whooping cough outbreaks) and new vaccines. A noticeable change to the recommendations was the statement that boys may now receive the human papillomavirus vaccine:

'HPV4 may be administered in a 3-dose series to males aged 9 through 18 years to reduce their likelihood of genital warts.'

Sure to generate plenty of commentary. Let's take a look at the CNN report, 116 comments and counting. Let the vaccine hating begin.

Genital warts, Cancer and HPV

Regardless of what you may have heard about chlamydia it's actually HPV, Human Papillomavirus Virus, that is the most common sexually transmitted infection in the US. One of the reasons for this is that in many cases the infected person has no signs or symptoms. Because of this the CDC estimate that by the age of 50 more than 80% of American women will have contracted at least one strain of genital HPV.

Whoa. Screechy noise. Backup.  By the age of 50 more than 80% of American women will have contracted at least one strain of genital HPV.

Although only a small percentage of these women will develop cervical cancer the fact that such large numbers of women are infected each year means that up to 1 million American women are diagnosed with cervical dysplasia each year. Cervical dysplasia, caused by HPV, is a precursor to cervical cancer and is painful and costly to treat. Of these 1 million cases each year about 11,000 subsequently develop cervical cancer and about 4,000 of these women will die. Every year.


So a safe and effective vaccine is going to be a great discovery right?

Widespread vaccination has the potential to reduce cervical cancer deaths around the world by as much as two-thirds, if all women were to take the vaccine and if protection turns out to be long-term. In addition, the vaccines can reduce the need for medical care, biopsies, and invasive procedures associated with the follow-up from abnormal Pap tests, thus helping to reduce health care costs and anxieties related to abnormal Pap tests and follow-up procedures.

—American National Cancer Institute

Because so many women are infected it is clear that women need to be vaccinated before they can become infected. The best way to do this is to vaccinate them before they become sexually active .

Oh oh. We used the sex word.

 

 

Wait, am I missing something here? We leave it up to private companies to develop vaccines and then we find it somehow sinister if they push for mandatory vaccinations when they develop an effective vaccine against a disease that kills thousands. Oh and did I mention that it is estimated (by the CDC) that at any one time 1% of sexually active adults have genital warts (also caused by HPV).

Don't make me post the genital wart pictures....

Mercury in vaccines

A number of people asked about the issue of thimerosal, a mercury containing compound used as a preservative in many vaccines. There is a lot of information about this issue at the CDC website. One thing that may have confused many people is that despite there being 'no convincing evidence of harm caused by the low doses of thimerosal in vaccines' it was agreed that thimerosal use should be reduced or eliminated in vaccines as a precautionary measure. A number of countries have done this now, and some countries have now been using vaccines without thimerosal for decades.

This has allowed for some massive studies looking at all sorts of health related issues in children both before and after the use of thimerosal ceased. If this compound was really causing health problems in children we'd see a dramatic change as we stopped its use. However these studies have generally showed little effect and in a number of cases diseases like autism continued to rise in countries after they ceased using this preservative.

The WHO concurs with the CDC in finding no evidence of toxicity from thiomersal in vaccines and no reason on safety grounds to change to more-expensive vaccines.

There are now a massive amount of studies on vaccine safety, particularly the common childhood vaccines. Like all science the results may appear at times to be contradictory and confusing. One way to judge the validity of a website is to consider how it deals with this issue. Both the CDC and WHO websites contain summaries of all the large studies and make a recommendation based on the sum of the evidence.

Other websites, particularly those promoting an an anti-vaccine agenda, tend to cherry pick studies that conform to their view. Science doesn't work that way.

Disappearing needles

There's a fun set of articles in this month's Wired magazine about what happened to the future that we were dreaming of 30, 40 or 50 years ago. You can probably imagine it: where's my jetpack? where's my robot helper? and why isn't my food in pill form? It doesn't seem to be on the Wired website yet but I'm sure it will be.

However the thing about the future is that we generally try to imagine it in terms of today's technology. The real smart folks are the ones who take the latest cutting edge technology and think 'what could I use this for?'

The following press release from Georgia Tech on a paper out in Nature Medicine this week made me think of this.

Disappearing Needles: Vaccine-Delivery Patch with Dissolving Microneedles Eliminates “Sharps” Waste and Improves Protection

A new vaccine-delivery patch based on hundreds of microscopic needles that dissolve into the skin could allow persons without medical training to painlessly administer vaccines – while providing improved immunization against diseases such as influenza.

Patches containing micron-scale needles that carry vaccine with them as they dissolve into the skin could simplify immunization programs by eliminating the use of hypodermic needles – and their “sharps” disposal and re-use concerns. Applied easily to the skin, the microneedle patches could allow self-administration of vaccine during pandemics and simplify large-scale immunization programs in developing nations.

AIDS antibodies

Well, we don't start talking about HIV and AIDS until Tuesday but this weekend saw the publication of two papers in the journal Science that are probably the most hopeful news for an eventual AIDS vaccine for a long time.

Take a deep breath and we have:

Xueling Wu, Zhi-Yong Yang, Yuxing Li, Carl-Magnus Hogerkorp, William R. Schief, Michael S. Seaman, Tongqing Zhou, Stephen D. Schmidt, Lan Wu, Ling Xu, Nancy S. Longo, Krisha McKee, Sijy O'Dell, Mark K. Louder, Diane L. Wycuff, Yu Feng, Martha Nason, Nicole Doria-Rose, Mark Connors, Peter D. Kwong, Mario Roederer, Richard T. Wyatt, Gary J. Nabel, and John R. Mascola. Rational design of envelope surface identifies broadly neutralizing human monoclonal antibodies to HIV-1. Science, 2010.

Tongqing Zhou, Ivelin Georgiev, Xueling Wu, Zhi-Yong Yang, Kaifan Dai, Andres Finzi, Young Do Kwon, Johannes Scheid, Wei Shi, Ling Xu, Yongping Yang, Jiang Zhu, Michel C. Nussenzweig, Joseph Sodroski, Lawrence Shapiro, Gary J. Nabel, John R. Mascola, and Peter D. Kwong. Structural Basis for Broad and Potent Neutralization of HIV-1 by Antibody VRC01. Science, 2010.

Several newspapers summarized this research but the report at ScienceDaily is one of the more comprehensive.

Scientists have discovered two potent human antibodies that can stop more than 90 percent of known global HIV strains from infecting human cells in the laboratory, and have demonstrated how one of these disease-fighting proteins accomplishes this feat. According to the scientists, these antibodies could be used to design improved HIV vaccines, or could be further developed to prevent or treat HIV infection. Moreover, the method used to find these antibodies could be applied to isolate therapeutic antibodies for other infectious diseases as well.

Whooping cough vaccination

A whooping cough epidemic was recently declared in California, with 910 recorded cases of whooping cough and 5 infant deaths reported as of June 15.
Whooping cough, a highly contagious bacterial disease, also known as pertussis, is generally a minor disease for adults but can be a very unpleasant, and even deadly, disease in infants and children.

Public health officials say California's lackluster immunization rates could be a factor in the epidemic spread of whooping cough, a bacterial disease expected to take its largest toll in the state in five decades.

California is one of only 11 states that does not require middle school students to receive a booster shot against whooping cough.