1. Resurgence of Vaccine Preventable Illnesses
Thomas Dobbs, MD, MPH
State Health Officer
Mississippi State Department of Health

2. We are fortunate…
The CDC estimates that vaccinations will prevent more than 21 million hospitalizations and 732,000 deaths among children born in the last 20 years.

8. Immunity and Immunization
Exposed to a pathogen (virus, bacteria etc…)
Become ill (maybe die)
If survive – immune system banks information on the germ to fight it in the future (and prevent illness)

9. Immunity and Immunization
Exposed to a protein (small piece of the germ) or a weakened strain
Immune system recognizes as enemy and develops defenses
No clinical illness
Future protection from that germ

10. We are spoiled…

11. Pertussis in Japan
In % of Japanese children vaccinated against pertussis (whooping cough).
393 cases of pertussis were reported in the entire country, and there were no deaths from pertussis.
Rumors began to spread that pertussis vaccination was no longer needed and that the vaccine was not safe, and by 1976 only 10% of children immunized.
In 1979 Japan suffered a major pertussis epidemic, with more than 13,000 cases of whooping cough and 41 deaths.

12. Measles Highly contagious febrile, rash illness
30% of cases with complications
Pneumonia and meningitis most common causes of death from measles
Subacute Sclerosis Pan- Encephalitis

13. Why is measles an issue now?
We have a highly effective and safe vaccine
In the 1980’s – campaign for worldwide measles eradication

15. Vaccine
Study of 12 Children GI
Disorder
Autism

17. Wakefield Article 1998 Lancet article linking MMR to Autism
Investigations of article: manipulation/fabrication of data
Trial lawyers in England paid Wakefield £400,000 ~1996 to find a link between vaccines and autism
Wakefield had filed patent for his own autism safe measles vaccine
Other authors retracted article
Lancet retracted article
Wakefield medical license revoked

18. Do Vaccines Cause Autism?No

23. How Contagious is Measles?

24. What is Population Immunity? And why is it important?

25. Herd Immunity Sustained transmission Transmitting case Susceptible
Case (A)
Immune (B)
Transmission
terminated
Susceptible (C)
(Indirectly
Protected)
The mass vaccination campaigns allowed health authorities to achieve “herd immunity”.
The theory behind the development of “herd immunity” is: in diseases that can be passed from person to person, it is more difficult to pass that disease easily when there are those who are immune to it. The more immune individuals there are, the less likely it is that a susceptible person will come into contact with someone who has the disease
For example, if “Person A” had smallpox and exposed “Person B” who was immune because of vaccination, “Person B” would not get ill and could not pass on the disease to “Person C.” when he comes into contact with him. So even if “Person C” is not vaccinated, he gets indirectly protection from the disease.

26. 0 % Immunity
90 % Immunity
95 % Immunity 1 1 1 18 2 1 4
324 8
Measles Transmission and Population Immunity
5832

27. Herd Immunity Thresholds for Selected Vaccine-Preventable Diseases
Immunization Levels
Disease Ro
Herd Immunity
1999
19-35 Months
Pre-School
Diphtheria
6-7
85%*
83%* 9%
Measles
12-18
83-94%
92%
96%
Mumps
4-7
75-86%
97%
Pertussis
12-17
92-94%
Polio
5-7
80-86%
90%
Rubella
83-85%
Smallpox
80-85% __
This slide shows the estimated herd-immunity thresholds needed to stop transmission for several communicable diseases.
The Ro , or the number of usual secondary transmissions from a single case of the disease, for several vaccine preventable diseases
Notice that smallpox is actually less “transmissible” than measles and pertussis
What this slide doesn’t show is the fact that even if desired herd immunity levels can be reached, outbreaks of the disease can and still do occur, though not to the extent they occurred before larger-scale immunity was achieved
Because outbreaks of disease can still occur even when a high level of herd immunity is achieved, other measures were ultimately also needed to accomplish the eradication of smallpox
*4 doses
† Modified from Epid Rev 1993;15: , Am J Prev Med 2001; 20 (4S): , MMWR 2000; 49 (SS-9); 27-38

28. Population immunity and Flu vaccine (50% reduced infectiousness) Ro – 1.5
Cycle 0%
Immune
50%
immune
100% 1
1000 2
1500
1125
750 3
2250
1265
563 4
3375
1423
422 5
5062
1602
316 6
7594
1802
237 7
11390
2027
178 8
17085
2280
133

30. It’s a small world after all

31. Vaccine Preventable Illnesses of the Future…
Cervical and Head/Neck Cancer
Ebola
HIV?
Tuberculosis?

33. Oropharyngeal Cancer in MS
From 2012 – cases of cancer of oropharynx
AA – / 100,000
Caucasian – / 100,000

34. Cervical Cancer in Mississippi
From , 738 new cases of Cervical Cancer were reported, and 292 women died of cervical cancer in Mississippi.
For every 100,000 women in MS, 9 new cases of cervical cancer were reported.
Mortality 2x higher in African American women

35. Squamous Cell Cancer
70% of head/neck squamous cell cancer is attributable to HPV virus!
~100% of cervical cancer
We have an effective anticancer vaccine – ONLY 52% of girls and 39% of boys complete vaccine series

36. HPV Coverage in Mississippi