Infectious Disease

The Power of Herd Immunity

The state of California is currently debating legislation that will require all children to be vaccinated. Senate bill 277 will ensure that 10 childhood diseases will be prevented as the law will direct that vaccines for these diseases must be administered prior to admission to kindergarten or any daycare setting. Under this proposed law, only medical exemptions will be allowed to circumvent mandatory vaccination.

Vaccine exemptions exist in many forms and vary from state to state as to which are legal and how they are granted. One major type is that of a personal exemption. These exemptions are based on the belief that vaccines do more harm that good or that calling for mandatory vaccination is an infringement on personal liberty, that no government entity has the right to mandate vaccination. Personal exemptions however greatly undermine the power of medical exemptions which are important for those who cannot be vaccinated due to documented medical conditions. Religious exemptions are granted when vaccination policies are at odds with a person’s religious beliefs. Of the exemptions I have just briefly described, religious and medical exemptions appear to be the most reasonable to grant as the practice of one’s religion is a right granted by the constitution while medical as I mentioned is stating that the vaccine could be harmful to an individual’s health due to a preexisting medical condition.

No matter which of the three exemptions are granted, vaccination is still very important. Establishment of herd immunity and maintaining a high percentage of vaccinated individuals within a population reduces the incidence of disease within a population. How? I will use a very simplistic example with ten people (we know that this is an inappropriate sample size, but this is to illustrate the point).

Scenario 1: Of the ten people in this population, only 1 is vaccinated (10% vaccination rate), 1 person is infected (10% infection rate) and the remaining eight people are not vaccinated. Thus, we have 80% of this example population that is susceptible to disease and with a low vaccination rate, infection is rapid among the non-vaccinated.

Scenario 2: Vaccination rate increases to 50% (5 vaccinated individuals), only one infected individual and four non-vaccinated. Here, susceptibility has been halved from scenario 1 (40%) but it is still not enough to keep infection from passing readily through this population.

Maximum protection of the population (vaccinated as well as the non-vaccinated), we need the vaccination rate to be at 90% or higher and only 10% of the population is susceptible to infection. Looking at that, 10% may still be too high of a susceptibility rate but what this number really means is that the chances of infection are greatly lowered and can really be better defined as sporadic. This is due to the high percentage of the population that acts essentially to buffer the effects of the infection among the population.

In a perfect world, 100% of the population would be vaccinated, thus no one would suffer from disease. A rate of 90% is acceptable, although with the current state of vaccination in the U.S., this number has dwindled, placing us in a very dire state. If not for yourself. vaccinate for the good of all. Our fortunes against infectious disease rise and fall with every action we take or every opportunity we squander.

Rubella elimination in the Americas and the Vaccine effectiveness argument

Vaccines are arguably the most successful public health intervention of the 20th Century. The successes that have been noted in reducing disease and deaths are immeasurable and hopefully there are many more successes to come with the current work being done with Polio. Within the last 15-20 years, the anti-vaccine movement has become a major player not only in debating the effectiveness and safety of vaccines, they have become an entrenched force that has driven down the community (Herd) effectiveness of vaccine through their non-compliance with vaccination standards. Many of their main arguments are invalid (autism/vaccine link) and their stubbornness to comply claiming personal exemptions bring harm to children. Each position previously mentioned is one in the same since many anti-vaxers forgo vaccines because of a personal belief and/or their rights are being infringed upon by a paternalistic governmental force.

This week, it was reported that Rubella has been eliminated from the Americas. This is highly historic as the efforts and gains made in the Americas can begin the worldwide elimination of Rubella worldwide. To what can we thank for this development? It would have to be the MMR vaccine! Through the use of the MMR vaccine, we have the power to eliminate vaccine prevenatble disease worldwide to end major suffering. Vaccine preventable diseases can be eliminated from out world and bring about a higher standard of health, improving life expectancy, reducing infant and child mortality due to these diseases and have a major effect on health costs.

Preventative health from a vaccination standpoint makes sense as we look not only to reduce disease burden, but we also want to reduce health costs for treatments later in life. Vaccination is an investment, there are costs to vaccination but those paying the costs must see these costs as investments in individual and community health. These investments MUST be made at the beginning of life to control health costs at the end of life. More investment at the front end keeps health costs low, improves overall coverage for all and can allow for coverage more more acute and complex health issues later in life. There is no excuse for not wanting to vaccinate when we can see that their effects on disease burden are obvious!

The tug-of-war between pro-vaccine and anti-vaccine movements continue. With smallpox declared eradicated 35 years ago and two other diseases heading towards eradication, another check can be placed in the column for the pro-vaccine movement while the foundation of the anti-vaccine movement suffers another blow.

HIV Epidemic in Southern Indiana: Why the social aspects of disease need to be addressed

Last week, the CDC declared a HIV epidemic in Scott County Indiana. As early as January, there were seven noted cases of HIV in an area that suffers from high levels of poverty and injection drug use. Both poverty and drug use as social factors are very commonly seen in many populations and drive HIV rates. It has been known for many years that sharing needles with someone who is HIV positive is one major means of contracting the virus. What we have not done as a society is to address head on the issues that drive infection rates. Why have we not established needle exchanges to provide clean needles for addicts?

Gov. Mike Pence (R-Indiana) with advice from the CDC team in Scott County agreed to allow temporary needle exchanges to slow the infection rates. What Gov. Pence is not doing is allowing for the establishment of exchanges for a longer term. For Gov. Pence and many on the political right, needle exchanges are a problematic issue. Saying “needle exchange” in politically right leaning circles in akin to saying that you support illicit dug use. The British government during the term of Margaret Thatcher instituted needle exchange programs for the good of the health of the United Kingdom. The decision although politically divisive, saved lives and it helped to reduce HIV infection rates among IV drug users dramatically. To me, this issue is a no brainer. Short-term needle exchange programs will be helpful in Scott County, but in order to not repeat an epidemic of this magnitude or worse in an area where poverty drives a culture where sexual networks can form and the drug culture is rampant. Political views override the best interests of many in this country.

Needle exchanges, while allowing for addicts to stay safe and reduce the chances of contracting HIV doesn’t halt the use of drugs. What if we could offer rehabilitation while these exchanges operate? It would stand to reason that there are factors which lead individuals to drug use, during an exchange while we are offering them protection against reusing/sharing used needles we could also  develop and expand resources to help individuals break the addiction cycle. But if we break teh cycle of addiction by dealing with all of the underlying factors associated with a particular person’s addictions, then how do they continue on a clean path when poverty continues to be prevalent and pathological in their community. I do not have the answers on how poverty can be conquered, but it starts with opportunity. So many of our politicians say that they are pro-USA for jobs and manufacturing but they continue to sanction loopholes for corporations that ship jobs to other countries. Poverty persists because those who want to work and want to make a LIVING WAGE cannot do so because of the lack of semi-skilled work. Not every job should require a college degree but with the right training, we can provide work that gives every impoverished American the ability to contribute to all aspects of our economy. HIV is not just about a disease, it is very much about the factors that lead to acquiring the disease. Until we see that diseases such as HIV, TB and neglected tropical diseases are intimately linked with poverty, we will continue to struggle with controlling or eradicating their deadly effects from our world.

Protect yourself, protect others during this flu season

Lately I have moments where I ask myself why am I still on Facebook. It was so much better in college, now it has lost it’s luster and fun. But I remind myself that the major reason I hang on is to keep in touch with friends and most importantly family. It was family that prompted me to write this blog entry as you can learn and get so much from a Facebook status. As I scrolled my timeline yesterday, one of my cousins stated that she was sick but she was going to press on to church. Hmmmm…now don’t take this the wrong way as I do not want to make this a blog entry about going to church. Nor do I want to pick on church but I want to talk about going places like church when we are sick and in the midst of a horrific flu season. I understand the need and the desire to attend church weekly as we are taught. However,  I have always been very uncomfortable sitting in a service in the middle of winter with multiple people within earshot and far away coughing as if a lung is going to pop out and/or sneezing into tissues, sleeves or their hands. I know if I am sick, honestly the last thing I am thinking about is going anywhere but most especially I would not want to expose any mass gathering of people to my germs. 

I cannot think of any minister, pastor or bishop who would tell you to not come to church under any circumstances. These folks are constantly encouraging you to come in, take your seat and worship. When you enter, you should feel that you are entering not only a sacred space, but a stress-free space where the worries of the day and the week past and coming can melt away. But then the coughing starts behind you, the sneezes start next to you and your stress level increases. As your stress level increases, your immunity drops and leaves you more susceptible to getting sick. No one wants you to NOT come to church, but when you are sick I think the man upstairs will truly understands if you sit one out in order to not only get yourself well but to also reduce the chance to getting others (the very young, the elderly and everyone in between) sick with your germs. That’s right, the population that you encounter in church, on your job and in other public places vary and many like the elderly and the young have immune systems that may not be as vigorous and robust enough to shake off exposure to cold and flu viruses. Or think about this another way if you go to church sick: If you were healthy, how would you feel if you were near someone who had the potential to make you sick from a cough, a sneeze, a handshake or touching a surface that may have germs on them? Not a good feeling thinking about it that way is it?

Many denominations have been very proactive in speaking to their member churches and providing guidance on gently encouraging parishioners to not attend services when sick, reducing contact among members during services and in some cases modifying communion protocols to reduce germ spread. Many of these items are common sense but because of our commitment to attending services, it unfortunately has to be said in order to show the importance keeping the chances of spreading disease to an absolute minimum. I ask you to heed these recommendations if they have been shared in your church community. If they have not been, use sound judgement and don’t go to church when you are very sick. Remember, if you don’t want someone to make you sick, why would you do that to someone else?