Vaccination & epidemic

[Griff]

To me, the concern is that like Wall Street and big agriculture, the pharmaceutical industry writes its own rules and regulations so at some point we cross the line from public health to public purse with little regard for unexpected consequences (like maybe increasing rates of autoimmune disease) which the Feds will indemnify them for anyway. Its corporate capitalism at its finest. The balance may not be as clear as individual vs group. It may be individual vs industry vs group. That extra component may have little to do with public health.

[Lamplighter]

Griff, I absolutely agree with your opening remark.

The rules in Medicare Part D (drugs) are a big culprit because Medicare
is prohibited from negotiating $ with the drug companies.
The other parts of Medicare and governmental agencies
are allowed to "controll" cost via negotiation of purchase price,
or by the amounts the feds reimburse to hospitals and physicians.

As an example, ObamaCare requires preventative immunizations to be free.
Except..., the immunization for shingles (varicella-zoster by Merck)
is exempted for large insurance plans, and the "co-pay" is passed along to the patient.
My co-pay was $70, and RiteAide starts the bidding at $200
It's additionally frustrating because the Merck vaccine is only 50% effective.

If you want the costs of drugs to go down, get your State's Senators
and Representatives to change this aspect of Part D.

Hint: For the other parts of health care costs.
When you get a survey about how satisfied you are
with your recent visit at a hospital/clinic,
answer it carefully because negative replies weigh heavily
in the future towards the rate of reimbursements for that health provider.

Wait-times in the ER Waiting Room don't count
because there are no standards to be met.

[Clodfobble]

Originally Posted by anonymous

strep throat is just the most common result of streptococcus infection, more severe are rheumatic fever, necrotizing fasciitis or flesh-eating bacteria, toxic shock syndrome and PANDAS

And yet, despite receiving two Prevnar shots with a total of (I believe) fourteen strep species in the vaccinations, my son later had intractable S. pyogenes necessitating tonsillectomy and adenoidectomy, in addition to PANDAS. Sometimes there are things to blame other than noncompliant "scared" parents.

Originally Posted by Lamplighter

No studies reported diarrhoea or rotavirus deaths, but all studies showed reductions in hospitalizations...

...OTOH while death is an easy endpoint to measure,
it is certainly not the be-all, end-all justification for public health.

Here, Dana, you can see an example of someone who is interested in more than just reducing a tragic death rate in a handful of diseases. I find Adam Corolla's "slippery slope" mock-up video as hilarious the next guy, but I am nonetheless very wary of people who are unable to draw a line somewhere. Your (universal your) line may be different than mine, fine, but "no line" is not a good basis for public policy.

[anonymous]

prevnar addresses S. pneumoniae. does not address S. pyogenes. i am very sorry to hear about your son.

[Clodfobble]

Right, and thus does not address...

Originally Posted by anonymous

rheumatic fever, necrotizing fasciitis or flesh-eating bacteria, toxic shock syndrome and PANDAS

There are 90 strains of pneumonia-causing strep alone. The current shots cover 80-90% of those cases, but they are trying to add more. Because of course as we vaccinate for the primary species, the lesser strains will simply rise to prominence in the niche we created for them.

Then after that, how many other new shots will it take to cover all the other strains of all the other strep diseases? How long before there is a 91st strain of S. pneumoniae? It's a losing battle. We will always have horrible diseases. The herd will always get thinned, one way or another.

[Happy Monkey]

Don't vaccinate for anything if you can't vaccinate for everything?

[Clodfobble]

*shrug* Or treat vaccination as a serious medical intervention, like antibiotics (ought to be,) and only use them when absolutely necessary, like antibiotics (ought to be.)

[Happy Monkey]

Vaccination is a preventative. If you need serious medical intervention, it's too late.

[Clodfobble]

Some shots, such as tetanus for example, can be given shortly after a known exposure. In addition, shots can be given in local areas during specific outbreaks instead of nationwide for all possible diseases. Mothers can be tested for diseases such as Hep B instead of giving all babies the shot when they will almost certainly have no exposure. There ARE options.

Antibiotics can be used preventatively across the board too. But it's strongly discouraged, and for good reason.

[Happy Monkey]

And those options are used to determine which vaccinations are on the schedule.

For example, rabies is not, while Hep B is:

Originally Posted by CDC

Approximately 25 percent of children who become infected with life-long hepatitis B virus would be expected to die of related liver disease as adults. (emphasis theirs)
...
In addition, approximately 33,000 children (10 years of age and younger) of mothers who are not infected (emphasis mine) with hepatitis B virus were infected each year before routine recommendation of childhood hepatitis B vaccination.

[Clodfobble]

And I believe their determinations should be more conservative than they are. As we've established, I am relatively unmoved by death stats, because I think the consequences of our actions will be worse than the original problem, and sooner rather than later. We're not even trying to make it later, in my opinion.

[Happy Monkey]

Are you relatively unmoved by the conflict between:

Originally Posted by Clodfobble

Mothers can be tested for diseases such as Hep B instead of giving all babies the shot when they will almost certainly have no exposure.

Originally Posted by CDC

In addition, approximately 33,000 children (10 years of age and younger) of mothers who are not infected (emphasis mine) with hepatitis B virus were infected each year before routine recommendation of childhood hepatitis B vaccination

[Clodfobble]

Yes, I am. Because on a surface level, your stats are for all children under age 10, not newborns. An 8-year-old is more likely to come into contact with adult fluids than a newborn. The shot could be given at age 1 or 2 or 3, just like many shots, were it not for some infected mothers passing it through breastmilk. They could test the mothers, but they don't. I understand that you believe that there is no risk difference between giving the shot on day one vs. day 730, but given that I don't believe that, it makes sense that I would advocate testing the mothers, and giving the shot later if that's what the parent wants to do.

I am also unmoved because on a deeper level, yes, children under the age of 10 get diseases. So do people over the age of 10. It sucks. It's painful. Sometimes it kills us. That doesn't mean that our current course of action will be better for us in the long run than the mechanism that evolution already provided.

You guys keep pointing out how horrible option A is, but I'm not denying that. I'm simply saying that option B may actually turn out to be much worse. Why do we not also give children under 10 a steady dose of antibiotics every day? That, too, would prevent many diseases which hurt and sometimes kill us. It's what they do with penned-in cattle, after all. And have there perhaps been any negative consequences from that policy?



Of course every single childhood death should be prevented at all costs! But maybe...[/Louis C.K.]

[Lamplighter]

Gee Clod, so many factual errors in your discussion.

Most of the current vaccines are for viruses, so discussion giving antibiotics instead is immaterial.

Back to talking about Hepatitis B,
HBV is transmitted by percutaneous or mucosal exposure
to the blood or body fluids of an infected person, most often through injection-drug use,
from sexual contact with an infected person,
or from an infected mother to her newborn during childbirth.

The risk for chronic HBV infection decreases with increasing age at infection.
Among infants who acquire HBV infection from their mothers at birth,
as many as 90% become chronically infected,
whereas 30%–50% of children infected at age 1–5 years become chronically infected.
This percentage is smaller among adults, in whom approximately 5% of all
acute HBV infections progress to chronic infection.
At least 50% of these chronic infections eventually lead to the person's death due to liver disease.

If you look for studies about the efficacy of only screening pregnant women,
and immunizing only the mother, or immunizing the newborn, or
immunizing the newborn AND giving HBIG (immune globulin),
you find that your scheme just doesn't work.

A significantly greater percentage of children with HBeAg-positive mothers
tested positive for antibodies against the hepatitis B core protein (16.76%) and HBsAg (9.26%)
than children with HBeAg-negative mothers (1.58% and 0.29%, respectively; P < .0001 and <.001).

Among the HBV-infected children, the rate of chronicity also was higher
among children with HBeAg-positive mothers than children with HBeAg-negative mothers (54% vs 17%; P = .002).
Similar rates of antibodies against the hepatitis B core protein (0.99% and 1.88%; P = .19)
and HBsAg (0.14% and 0.29%; P = .65) were noted in children born to HBeAg-negative
mothers who were or were not given HBIG.

Infantile fulminant hepatitis developed in 1 of 1050 children who did not receive HBIG (.095%).

I understand your warning about potential, future bad things happening... maybe.
But bad things are happening now, and that's what public health is all about... dealing with reality, not the theoretical.

[Clodfobble]

Sigh. It's not about giving antibiotics instead of vaccines, it's about why something that seems beneficial might have unintended negative consequences. It was a parallel example, not a suggestion. Christ Almighty, if you really think I'm in favor of daily prophylactic antibiotics, you have paid zero attention to who I am.

I sincerely hope vaccinations work out for you and your family. Meanwhile I shall continue to do the risk assessment for my own family and make my own decisions accordingly. Everything else is kind of pointless, no?