age-limited access to health care

Access to health care is usually presented as a function of income, proximity to services, or cultural dictates. Oddly, it can also be a function of age: Children also need a birth certificate to be eligible for the vaccination programme available to under five year olds. Those who are ineligible are left vulnerable to preventable diseases, a common problem in Cameroon. Given the child mortality rates (i.e. deaths under 5 yrs age) in under-developed countries, and the urgency to vaccinate as a public health measure ... I'm stunned that the gov't would refuse to vaccinate anyone under 5 just because of a birth certificate. I understand the need to control when the child gets vaccinated and make sure the child doesn't get too many. Although I'm equally sure that if the parents are well-off they could get their kid the shots.

Myth (the myth of objective educated opinions)

Myths pervade even public health. Yesterday's Midmorning program had as guests professors of

infectious diseases @ Mayo

public health professor @ Pitt, and

pediatrics @ Indiana U.

Public health officials are trying to figure out why a majority of Americans, including many public health nurses and doctors, have told pollsters recently they are wary of the H1N1 vaccine. Wary to the point that they're not sure they will get the shot against H1N1 flu. A look at medical myths and what fuels the fear of vaccines.

This I need to hear. My opinion, prior to doing so, is that medical & public health officials are

a) inadequately educated about vaccines & how they are made

b) subject to the ignorance of peer-education. Rather than peer pressure, this is peer pressure exerting influence about facts. If all of my patients/clients believe it, it must be true.

Pilgrimage & Polio

Saudi Arabia: Pilgrims Who Travel to Mecca This Fall Will Get an Oral Polio Vaccine on Arrival By DONALD G. McNEIL Jr. Published: September 28, 2009 New York Times Saudi Arabia has announced that everyone arriving for the annual pilgrimage to Mecca in November will have to swallow a dose of oral polio vaccine under the eyes of health officials. The kingdom has become more and more aggressive in its fight against polio, which has hovered on the brink of eradication for years. Until recently, the Saudi authorities asked for proof of vaccination when pilgrims applied for visas and forcibly vaccinated only those arriving from countries where polio was endemic. In New York last week, the country’s foreign minister, Prince Saud al-Faisal, and Ted Turner, the cable television billionaire and chairman of the United Nations Foundation, announced that Saudi Arabia would donate $30 million toward global polio eradication. While that is only a small contribution to the $6.1 billion spent over the last 20 years, it is symbolically important. Polio is endemic in only four countries: Pakistan, Afghanistan and regions of Nigeria and India with a Muslim majority. It persists largely because of a persistent rumor that the vaccine is a Western plot to sterilize Muslim girls. Each year, travelers from endemic countries seed outbreaks in other poor countries, where vaccination drives had been dropped when the disease was thought to have been eliminated. In some years, it has reached Saudi Arabia, where millions of pilgrims live close together in tent cities for the holy week.

Safety assays for vaccines

FDA struggles how to verify vaccine safety with such a high-pressure rush to produce? [radio story]

Not really unprecedented

Outbreaks of measles in U.K. mirrors problems we've had here. About 10 or so years ago, several universities started requiring incoming students to be vaccinated for measles.* This was at a point where the ACIP changed its recommendations for MMR vaccines (measles, mumps, and rubella/German measles). The traditional vaccination practices, they were discovering, were inadequate for long-term immunity. Fair enough; hey, this is why CDC has a reportable disease requirement. I realized that I am old enough to fall into that period. I figured I'd get vaccinated again. That's another story. I did. Not so for thousands of people who have decided to abrogate their personal & social responsibility. Yes, this is one point upon which I am both conversant and very strongly opinionated. Sure, I'm often opinionated; I try to be knowledgeable about it; I try to see other points of view. I've seen them here and they're irrational and scientifically unsubstantiated. Don't get me going on the whole thimerosal 'controversy' or 'conspiracy'. Maybe I'll make a different post on that, using the concepts of Risk Assessment to explain my opinion; it will take more time than I have right now to do this well and accurately. While I realize measles is far more common than mumps and rubella, and is therefore more immediate in people's minds, it is also the least risky of the 3 to long-term health. [I don't recall where I read this, so if it's not correct, please let me know.] It is a cogent example of ignoring a greater risk due to the fact that it's less likely to happen, and thus less likely for people to believe it has anything to do with them. Eventually the herd immunity will fall below the level necessary to effectively control these diseases. At which point, we're going to have an large outbreak, if not an epidemic. And, at which point, all of these "don't vaccinate my child; I'm the parent and know better" parents are going to line up and demand to know why the government hasn't done anything to prevent this. Failure to vaccinate your child or yourself against the major communicable vaccine-preventable diseases is inexcusable. Before you think I'm an ideologue on the point, there are other vaccine-preventable diseases for which I also consider less important. It's not an absolute yes/no question. But, it is not only the potential for disease, but also the potential consequences of communicating the disease. Polio - well, this is one where I understand a reluctance to vaccinate; however, considering the extent of global travel, it is no longer a valid argument that "we don't have it here, it's only over there [i.e., in some 3rd world country]." I understand, but do not agree with their argument. An interesting article in Minnesota Parent magazine addresses puts forth the problem in personal terms. (The stats are Minnesota-based.) There are also vaccines for rabies, anthrax, and monkey pox. I'm not about to get in line to have any of these, much less ask for them for my kids. [Although, as a point of disclosure, I have actually been vaccinated for the first two, but that was occupationally related and justified based upon a much higher risk of exposure than I have now.] Hey, cool - "Warning, some of these photos are quite graphic" notice for medical photos of these diseases (measles, mumps, rubella, polio (still & video), tetanus, diphtheria (personal note: these are the grossest) & pertussis . I bet if these were more widely available, it might change some people's choice about whether to get vaccinated, considering the current American obsession with body images. I realize there is legally an option to refuse to be vaccinated.** This in the past was generally used by some religious sects which object to any 'modern' medicine. We need to seriously and objectively assess the effectiveness and appropriateness of our current policies. The objectivity needs to be placed on all sides of the argument. * Currently, the Academic Health Center at the University of Minnesota (schools of medicine, nursing, dentistry, pharmacology, veterinary medicine and public health) require vaccination for HepB, DTP, MMR and annual TB tests. What a pain trying to get all the documentation for this, when school started! ** Non Medical Exemptions to School Immunization Requirements, secular trends and association of state policy with pertussis incidence, Omer, Pan, Halsey, et al., J. Am. Med. Assoc., 2006;296:1757-1763 as pdf and .htm ~~ concludes that the looser exemption rules are, the higher the incidence of disease. Other information: Advisory Council of Immunization Practices has an extensive list of vaccine-preventable diseases and individual information on both the disease and vaccine. ACIP is part of the Centers for Disease Control & Prevention (CDC). There is a new adult schedule posted here in .pdf and .htm versions. Summary of Notifiable Diseases (several years worth) The photos linked above are on the CDC website, but are from the Public Health Image Library.

stupidity in action

One of my biggest pet peeves is the "modern" belief that vaccinations are no longer necessary as a public health measure. of the measles patients, 33 were from Indiana and 1 resided in Illinois. Patients ranges in age from 9 to 49 (mean age: 12). Measles vaccination was documented for 2 persons, one of whom had received 1 dose, and one who had received 2 doses. [3 doses being the magic 'fully vaccinated' number]. MMWR, vol. 54, no. 42, pp. 1073-1074, 2005, Import-Associated Measles Outbreak Now, I realize that it is possible to get vaccinated and no have immunity (e.g., me). I also realize that vaccination does not provide life-long immunity (e.g., the patients over 40). But really, 31 of these people suffered through a case of the measles (and its attendant infection-related health problems) due to a simple refusal to vaccinate their children.