Immunization Question
Folks, I have a question. This is real, I'm not just using a rhetorical device.
This morning on my drive in, I heard a news blurb about the new Meningitis vaccine. Apparently, the recommendation now is that parents have children vaccinated if they go to sleep-away camps or off to college, and eventually (once there are enough stores of the vaccine) all children will be recommended to get the vaccine at age 11.
As part of the same story, however, they mentioned that there are either 115 or 150 (the person slurred a little bit) cases per YEAR, and that it is 15% fatal. That means there are maybe 25 deaths per year from meningitis.
If those statistics are true (and I tend to think so, because the news article was very pro immunizing the children, so it wasn’t presented as a counter argument), how do we consider the benefits to be worth the risks of a new and not-yet-widely-tested vaccine?
I have the same question about the chicken pox vaccine also, actually, at least in children. According to one site I found, there are about 4 million children’s cases of Chicken Pox per year. Of those, 4000 require hospitalization, or .1%. The mortality rate is 50-100 deaths per year, or about .005% of cases. Pretty good odds, especially considering that many of the 50-100 children who died did so because they weren’t properly cared for during their illness (kept inside and resting, etc). In adults, the mortality rate climbs to a rather high 10%.
So, with chicken pox, we have a disease which is very dangerous to adults but the danger to children is almost non-existent. We have a disease which, by contracting it, conveys a life long immunity, and we have a vaccine which (like most vaccines) starts losing its effectiveness at the 10 year mark.
So why would we recommend immunizing all children against Chicken Pox, saving them from getting it as children, and then dropping them into vulnerability at the point in their lives when A) it’s more dangerous to them, and B) most people stop paying close attention to getting their booster shots.
Would it not make a lot MORE sense to NOT immunize children, but to immunize teens who had not had the disease (or for whom the titer indicates insufficient immunity)?
But back to Meningitis… If there are really only 150 cases of this disease per year, the odds of contracting it are low, the odds of dying from it are low, and the risk of taking a new and not widely tested vaccine are high. Why would we do this? Am I missing something?
Liam.
posted by Liam at 8/30/2005 09:15:00 AM
4 Comments:
A complicating factor with chicken pox is that the same virus is also the cause of the very painful disease shingles. Shingles only happens in adults who had chickenpox as children; it happens because the virus (varicella zoster, a member of the herpes virus family) is never actually cleared from your system when you get over chicken pox, it is only kept down to such low levels that you are symptom free. If for any reason your immune system becomes somewhat depressed as an adult -- and we're not talking AIDS level or post-transplant-drugs immunosupression here; we're talking about the slowdown that occurs normally in the aged or infirm -- then shingles can form.
If on the other hand the child is immunized and never gets chicken pox, then shingles cannot occur.
(Immunizing teens who never had the disease or those with low titres still makes sense, as you suggested.)
As for the meningitis vaccine - couldn't the same thing have been said about the polio vaccine at one point in the fight against polio? Or smallpox? "This is now a very rare disease; why should we continue to vaccinate everyone?"
Furthermore, meningitis is rare in the population at large, but "College freshmen who live in dormitories are six times more likely than other people to be infected with meningitis, the CDC said. They have the country's highest rate of the disease at 5.1 cases per 100,000." So if the risk is higher in this population, it makes sense to concentrate efforts there.
Tuesday, August 30, 2005 10:51:00 AM
Actually, I'm not sure that immunization prevents shingles, and I don't think we've been testing it long enough to know whether it does or not.
Because as you point out, having chicken pox prevents you from "getting" it again because you have immunity to keep it from building up in sufficient quantities to cause the symptoms again.
So I wonder, does immunization keep you from having the virus in your bloodstream, or merely prevent it from building up in large enough quantities to cause disease?
Also, by the way, my wife was reading into it, and if I remember what she told me this morning (didn't sleep well, so I might not have, she'll probably jump in and correct me if I'm not), the vaccine isn't 100%. It will protect you against casual contact, but not against spending a week in a household with a child who comes down with the disease.
But are you CERTAIN about your comment that an immunized child can not get shingles? (I'm the first to admit, I'm not an expert in the biology of disease, so I'm completely open to someone telling me my limited understanding is wrong.)
Polio had a much higher incidence prior to vaccination than meningitis has. That’s what I’m getting at. If that 150/year number is true, then roughly the same number of people get it as win the PowerBall lottery each year. I’m not saying I want to be one of the 150 that get it, or the 15% of that number who dies from it, but I don’t think the odds are high enough for me to get the vaccine, and I certainly don’t think my odds are high enough that everyone ELSE should be forced to get the vaccine to lower my risk.
Even at 5.1 cases per 100,000 people per year, in the average 70 year lifespan, that 100,000 people would have roughly 360 cases, and that assumes a 5.1/100,000 risk factor life long.
Look, I’m not saying that people shouldn’t get the vaccine if they want it. I’m just not sure that the risk is high enough for me to want to take it, and I don’t think it’s fair to tell those who DON’T think the risk is high enough to warrant the virus that they have to take it to lower everyone ELSE’S risk.
Liam.
Tuesday, August 30, 2005 2:17:00 PM
The stats that I read this morning about cp vaccine. 50 to 100 deaths per year, adults count for over half, yet they only count for 2% of the cp cases. In my opinion GETTING the CP may be the best option. I know all about Shingles, a person close to me gets them from time to time and she finds it very uncomfortable. But, people die when they get CP as adults (at a much, much higher rate than children)
The arguments on using the vaccine to give immunity to children are mostly of the cash type. It costs billions of lost wages for a parent to take a week off of work. But, once we begin using the vaccine for CP, it becomes more and more important that we not have outbreaks. The vaccine gives 70% of those who take it immunity (and it is a live vaccine, so some will actually develop it from the vaccine, and they will have it for life at the levels discussed above). So we will have a percentage of adults who don't have immunity as the years go by. There is no risk for Liam and myself to have vaccinated children, we both have immunity due to catching it as children. But, if we immunized our 5 children, one probably won't have immunity. If that one is exposed as an adult to even one child who has cp (the virus), then my adult child has a good chance of developing cp and of being very very ill.
I think that society has made a mistake in vaccinating against this disease for primarily financial reasons. In fifty or so years, we might see increasing cases of adults getting cp.Then mortality will be much higher than 50 per year.
Tuesday, August 30, 2005 4:52:00 PM
Everything I have read says that if you did not have actual chicken pox, you cannot get shingles. Therefore a non-immune adult who never had chicken pox when exposed to the virus will develop chicken pox, not shingles. Of course if the adult survives the adult chicken pox case they then would be just as at risk for shingles as someone who had chicken pox as a child.
I am weighing your arguments in my mind; you may have changed my mind. However, as a childless person who had chicken pox as a child (twice!), I have effectively no stake in this argument and my opinion should not carry any weight.
Tuesday, August 30, 2005 5:19:00 PM
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