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
Baby’s Death • Centennial Centennial International International Exhibition, 1876 Exhibition, 1876 • Swedish Exhibit: Swedish Exhibit: Scenes in Scenes in the home life the home life of the of the Swedes Swedes • Infant mortality Infant mortality • 100/1000 LB 100/1000 LB (1900) (1900) • 6.1/1000 LB 6.1/1000 LB (2010) (2010)
Development of Immunity
Vaccinations • Vaccination ccination is a method is a method of giving antigen of giving antigen to stimulate to stimulate the the immune response to pr immune response to produce spec oduce specific pr ific protection against a otection against a given given disease without the morbidity and disease without the morbidity and mortality risk mortality risk of of that disease. that disease. • Vaccine effectiveness can be measured by preventing disease in ccine effectiveness can be measured by preventing disease in the individual and by preventing disease spread in the individual and by preventing disease spread in the the community community • Example: Measles-containing vaccine effectiveness Example: Measles-containing vaccine effectiveness • 93% after 1 93% after 1 dose dose • 97% after 2 97% after 2 doses doses
Paralytic Poliomyelitis • No cases No cases in US in USA since A since 2000 2000 • Wild-type virus remains Wild-type virus remains epidemic epidemic in 3 countries in 3 countries Pakistan Pa Afghanistan Afghanistan Nigeria Nigeria Polio sur lio survivors, Nigeria ivors, Nigeria OPV OPV, S Sudan (WHO photo) dan (WHO photo)
Anti-Vaccination: Then and Now • Capti 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 obes [??] their systems ems. Let Let Mayor Stuart forbid it at once.” Mayor Stuart forbid it at once.” -Su Sund nday Item ay Item , 1 , 1894, 94, Philadelphi Philadelphia • 70% US children age 1 70% US children age 19-35 -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 e 0-7% non-medical exemp emptions ions • Libertarian ( Libertarian (autonomy), R utonomy), Religious ligious
Community “Herd” Immunity • When most members of When most members of the community are pr the community are protected against a otected against a disease, spread of disease, spread of contagious disease is contagious disease is contained contained • Little opportunity for Little opportunity for outbreak outbreak • Lessens Lessens exposure posure risk for those risk for those not eligible not eligible for vaccine for vaccine • Infants Infants • Pregnant women egnant women • Immunoco Immunocompr mpromised mised • Vaccination pr ccination protects more than the vaccinated person otects more than the vaccinated person • More spreading in More spreading in communities with pock communities with pockets of ets of unvaccinated unvaccinated people people
Herd Immunity
Pertussis (Whooping Cough) USA, 1981-2011
Pertussis • 16 million 16 million cases/year worldwide cases/year worldwide • 195,000 deaths/year 195,000 deaths/year • Adolescents and olescents and adults have mild disease, often adults have mild disease, often unrecognized unrecognized • 50% 50% of of infant cases require hospitalization, esp. <6 infant cases require hospitalization, esp. <6 months months • California California • 10 deaths 10 deaths in 2010 in 2010 • 28,000 cases in 28,000 cases in 2014 2014 • Tdap Tdap vaccine in vaccine in pregnancy (27-36 weeks gestation) pregnancy (27-36 weeks gestation) • Passive infant immunity ssive infant immunity • Cocooning Cocooning
vaccinate your baby vaccinate your baby a pr a program of ECBT ogram of ECBT ever every child by two y child by two
Measles • Highly contagious Highly contagious • Coughi Coughing, ng, sneezing sneezing • Direct contact with secreti Direct contact with secretions ons • 4 4 days before – days before – 4 days after rash days after rash • Incubation period Incubation period • 7-21 days after e 7-21 days after exposure posure • Clinical presentation Clinical presentation • High fever (105 High fever (105 ⁰ F) x 4-7 days F) x 4-7 days • Malais Malaise • Cough, cor Cough, coryza, conjunctivitis za, conjunctivitis • Enanthema Enanthema (Koplik Koplik spots) spots) • Exanth Exanthem em (morbilliform (morbilliform rash) rash)
MEASLES: A dangerous illness Olivia, my eldes Olivia, my eldest daughter daughter, caught measle , caught measles when she was seven years when she was seven years old. As the illness took its usual co old. As the illness took its usual course I can remember reading to her urse I can remember reading to her often in often in bed and 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 one herself, I 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. - Roald Dahl, 1986 ald Dahl, 1986
Measles (Rubeola) USA, 1976-2011
Measles declared to be eliminated from US in 2000 • Measles elimination is 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 country) for region or countr 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 • Fewest c west cases = 3 ses = 37 (2004) (2004) • Most cases = 644 (2014) Most cases = 644 (2014) • 23 Outbreaks 23 Outbreaks • Ohio Amish, 383 cases Ohio Amish, 383 cases • 2015 (as of 3 015 (as of 3/27) 27) • 4 Outbreaks 4 Outbreaks • CA amu amusement sement park, park, 146 cases 146 cases • Lik Likely ly fr from om trave traveler er overs overseas as • Unvacc Unvaccinat inated ed
Progress Toward Measles Elimination — Philippines, 1998–2014 MMWR Weekly April 10, 2015 / 64(13);357-362
Saving our Children: A Global Issue • Nutrition Nutrition • Breastfee Breastfeeding • Protein – otein – calorie alorie • Micr Micronutri utrients ents • Vitami tamin A, n A, Vitamin D, tamin D, Zinc, Seleniu Zinc, Selenium • Sanitation Sanitation • Immunizations Immunizations • Avoid preventable deaths (>2 million/yr) oid preventable deaths (>2 million/yr) • Avoid preventable lifelong disability oid preventable lifelong disability • Cost effective: direc Cost effective: direct and societal and societal • Access to medical care ccess to medical care
Global Health Leaders Launch the Decade of Vaccines Collaboration (2010) • Coordination of Coordination of international international vaccine community vaccine community • Bill and Bill and Melinda Gates Melinda Gates Fo Foundation • Global V Global Vaccine ccine A Action Plan tion Plan • Discover Discovery • Development Development • World Health Organization rld Health Organization • Deliver Delivery (WHO) (WHO • To save >20M lives, 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 • UNICEF UNICEF costs, achieve >$800 billion in costs, achieve >$800 billion in economic gains economi gains as vaccinated as vaccinated children live longer children live longer, healthier , healthier, more pr more producti oductive lives ve lives • National Institute of Allergy and National Institute of Allergy and Infectious Diseases (NIAID) Infectious Disease (NIAID) • First Global V rst Global Vaccine Summit, ccine Summit, April 2013 in April 2013 in Abu Dhabi Abu Dhabi
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