Artist and father Daniel Arsham in support of vaccination.
Artist and father Daniel Arsham in support of vaccination.
Respiratory Syncytial Virus causes severe respiratory tract infections and worldwide claims the lives of 160,000 children each year. Scientists at VIB and Ghent University have succeeded in developing a promising vaccination strategy to counteract this common virus infection.
Xavier Saelens (VIB/UGent): “We discovered a new vaccination strategy that paves the way for the development of a novel approach to vaccination against RSV, a virus that causes suffering in numerous small children and elderly people.”
RSV: an infection that is difficult to combat
The Respiratory Syncytial Virus – abbreviated to RSV – is the most important cause globally of viral respiratory tract infections in young children. Children with a high risk of complications caused by RSV are sometimes treated preventively to avoid the infection, but this treatment is expensive and does not work therapeutically. Children with RSV infections are often hospitalized and primarily receive supportive care.
There is no medicine available yet that can effectively suppress an RSV infection. RSV infections are also common in the elderly and they can become severely ill as a result.
Searching for a RSV vaccine: prevention is better than cure
Previous attempts to develop a vaccine against RSV have failed miserably. A vaccine must prime our immune system so that it can protect us against a pathogen. The starting point in the development of a vaccine is usually the proteins that are present on the outside of the virus.
Many scientists and pharmaceutical companies are targeting the two large envelope proteins – F and G – in the development of a RSV vaccine, but these approaches are have yet to prove clinical benefit against disease caused by RSV.
Bert Schepens, Xavier Saelens and Walter Fiers (VIB/UGent) searched for an alternative strategy to attack the virus. They focused on a small, seemingly insignificant envelope protein of RSV, the so-called Small Hydrophobic protein (SHe). The immune system barely notices this viral protein during an infection with RSV. Therefore, the scientists linked the extracellular part of SH to another molecule. The resulting SHe conjugate did induce antibody production in laboratory animals.
New vaccine offers protection in lab animals
The SHe-specific antibodies do not neutralize RS virus in vitro. However, mice that were vaccinated with the SHe vaccine were protected against a challenge with the virus. The growth of RSV in the lung tissue of the vaccinated animals was significantly reduced and the animals did not become ill. The experiments were repeated in cotton rats as these animals are naturally more sensitive to RSV infections
The positive results were confirmed: pretreatment with the SHe-vaccine suppressed the replication of RSV in the lung tissue of the infected cotton rats.
Surprising mechanism of action
As no neutralizing antibodies were induced, the vaccine must offer protection via a different mechanism. The scientists also unraveled this mechanism. The SHe-specific antibodies stimulate macrophages (cells that absorb foreign particles) in the respiratory tract to such an extent that they selectively ingest (phagocytose) the virus-infected cells
Bert Schepens (VIB/UGent): “This alternative approach to battle RSV has never been studied before and this is exactly the pathway that is triggered by the new candidate vaccine. The SHe-based vaccine could be linked to other candidate vaccines directed against the larger envelope proteins of the virus, to double hit the virus: with neutralizing antibodies in addition to antibodies that stimulate macrophages to selectively eliminate infected cells”.
News Medical Net
When Edward Jenner proposed to the parents of 8-year-old James Phipps the risky idea that rubbing some stuff from sick cows onto the young lad might protect him from small pox, James’ parents faced a choice. It was 1794 and smallpox was ravaging the British population, and in that emotional environment, the fear of smallpox won out over the frightening idea Jenner was proposing.
With no data or experience to go on, James’ parents could only rely on their emotions and instincts. Since then, we’ve learned an immense amount about vaccination, firmly establishing that the benefits of vaccines far outweigh their real but minimal risks. But those facts don’t change the reality that we consider whether to vaccinate in a psychological choice environment shaped far more by our feelings than the facts alone. The modern vaccination program offers two clarion examples of the emotional nature of our risk perception system, and how it can sometimes get us into trouble.
1. Childhood vaccination.
Despite lots of alarming news stories about declining childhood vaccination rates, in general those rates remain high. The vast majority of parents worry more about the diseases than the vaccines that prevent them, or trust their health care providers and just follow their advice. (A full list of rates per disease, per state, are in this CDC chart.)
But small groups in some local areas either refuse to vaccinate their children at all (less than 1 percent of children overall in the U.S.) or choose not to vaccinate or to delay vaccination against some diseases. For example, in 17 states, local pockets of vaccine hesitancy have dropped the statewide average rates for measles/mumps/rubella below the 90 percent target.
The facts about the risks of diseases and vaccines are the same for the tiny group of vaccine refusers or the slightly larger group of those hesitant about the recommended schedule as they are for the general public. But the psychological choice environment in which the “refusers/hesitants” are making vaccine decisions is different. Some of those people don’t like the government telling them what to do. Some have particularly high fears of human-made risks, like vaccines. Some live in communities that place high priority on micro-level decision making about parenting. These different emotional risk perception factors lead them to worry more about the vaccines than the diseases, or mistrust the public health system that recommends vaccines, or the pharmaceutical industry that produces them.
As a result of those emotional differences, these people expose their kids and themselves and the public to far greater risk than the minimal danger of vaccines. But these choices are neither irrational, nor “science denialism,” as some academics and doctors and pundits dismissively label them. These choices are based on people’s legitimate and valid feelings. These choices are based on people’s legitimate and valid feelings, emotions and instincts we all we all use to assess the facts and gauge potential risk. The feelings and values and life experiences and circumstances of the refusers and hesitants just lead them to see the same facts about vaccines through different emotional lenses than most people do.
However, valid as those feelings may be, it is undeniable that they put those people, and their kids, and their friends and neighbors and communities, at risk.
2. Seasonal influenza vaccine
Childhood vaccination is getting most of the attention from the news media that now raises alarms about declining vaccination rates but just a few years ago was full of scary stories about the risks of vaccines, helping trigger the very decline about which they are now raising concern. But another form of vaccination offers a lesson about the potential danger of our emotion-based risk perception system; the regular vaccination for seasonal flu, which is now recommended for everyone 6 months old and up.
Childhood vaccination rates in the U.S. are above 90 percent. But in a good season, vaccination rates for seasonal flu hover around 40 percent for adults and 50 percent for children. According to the CDC, influenza kills 1,532 Americans a year directly, and contributes to the deaths of between 3,000 and 49,000. The number of people unvaccinated against the flu dwarfs the number of un- or partially-vaccinated kids. And the numbers of people who get sick or die from influenza, many of whom are young children with still-developing immune systems, dwarfs the number of people who get sick or die because childhood vaccination rates run low in some areas. Between the two, the low vaccination rates for influenza pose a far greater threat to public health in terms of illness and death. Talk about “irrational!”
But the psychological choice environment for whether to get a flu shot is different than the factors influencing concerns about childhood vaccination. When risks to kids are involved, fears almost always run higher. But flu is familiar, and familiarity with any risk reduces concern. The flu shot is always available, so we think that we can always go get one… a reassuring sense of control that seduces some of us into not worrying enough to get the shot in the first place.
We worry more about new UNfamiliar flu, or when there might be vaccine shortages and we lose that sense of control. But in normal times, far fewer of us get flu shots than should. And unless you’ve had a bad case of influenza, you’re like most people; you don’t think getting it is that bad… and when we don’t sense a lot of suffering from a risk, we don’t worry about it as much. (Trust me on this one. You REALLY SUFFER, for weeks or more, when you get a bad case of influenza, as millions do each year.)
Two vaccine issues. Two different sets of numbers, two different sets of emotional factors that cause some of us worry more than we need to, or less than we should. But together, these examples illustrate a single phenomenon; the Risk Perception Gap, the risk we face when our fears don’t match the facts. These examples help make the case that we need to recognize how powerfully the psychological choice environment shapes our judgments and behaviors, and account for those emotional factors as we try to make healthier choices for ourselves and for society.
Like any trench war, the fight to protect America’s kids against disease is proceeding only inch by inch. A new report shows why there’s reason for hope—and reason for worry
It’s just as well that no one knows the names of the 17,253 sets of parents in California who have opted not to have their children vaccinated, citing “philosophic” reasons for declining the shots. The same is true of the anonymous 3,097 in Colorado who have made the same choice—giving their far smaller state the dubious distinction of being dead last among the 50 states and the District of Columbia in the simple business of protecting their children against disease.
On the other hand, kudos to you, Mississippi, for finishing number one—with an overall kindergartener vaccination rate in the past school year of 99.7%—and to you, Louisiana, Texas and Utah, for finishing not far behind. Your children, by this measure at least, are the safest and healthiest in the country.
These and other findings were part of the alternately reassuring and deeply disturbing survey from the CDC’s Morbidity and Mortality Weekly Report (MMWR), looking at vaccination coverage for more than 4.25 million kindergarteners and the opt-out rates for more than 3.9 million in the 2013-2014 school year
The report’s top line number seems encouraging. The national compliance rate for the three major vaccines covered in the survey ranged from 93.3% (for chicken pox) to 94.7% (measles, mumps, rubella, or MMR) to 95% (diptheria, tetanus, pertussis).
But even those numbers don’t mean America has aced the test. Vaccination rates need to reach or exceed 95%, depending on the disease, to maintain herd immunity—the protection afforded by vaccinated people to those few who can’t be vaccinated, by giving the virus too few ways to body-surf its way across a population until it finds someone who’s vulnerable. So while a 90% vaccination rate might look like an A, it in fact may be no better than a middling C.
And in some parts of the country, the numbers are much, much worse. As I reported in TIME’s Oct. 6 issue, vaccination refusal tends to be a phenomenon of the wealthier, better educated, politically bluer parts of the country—the northeast, the Pacific coast and pockets around major universities. Those are communities in which folks know just enough to convince themselves that they know it all—which means they know better than the doctors, scientists and other members of medical community at large, who have overwhelmingly shown that vaccines are safe and effective.
That’s part of the reason New York City’s elite private schools have vaccination rates far lower than the city’s public schools, and why, according to a shocking story by the Hollywood Reporter, some schools in the wealthier neighborhoods of Los Angeles have a lower vaccination rate than in South Sudan.
Previous studies have concluded that overall vaccination reduces the risk of non-targeted infections among vaccinated individuals. Now new research presented at IDWeek 2014 suggest that the pneumococcal vaccine dramatically reduces severe antibiotic-resistant infections by as much as 62 percent among children.
Pneumococcal disease is a bacterial infection that causes sepsis, pneumonia, and meningitis as well as hearing loss, vision loss, and death. The infection is also the most common vaccine-preventable bacterial cause of death. The pneumococcal vaccine (PCV) should be administered at 2 months, 4 months, 6 months, and between 12 and 15 months as well as to children and teenagers in high-risk groups between 2 and 18 years old.
Explained lead researcher Sara Tomczyk, PHN, MSc, epidemic intelligence service (EIS) officer for the Respiratory Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta: “Pneumococcal infections can cause several clinical syndromes, including ear infection, pneumonia, and more serious infections such as meningitis and blood infections. Last year antibiotic resistance due to pneumococcal infections was deemed a serious threat in a large CDC report. It was estimated that it leads to more than 19,000 excess hospitalizations, 7,000 excess deaths, and $96 million in excess medical costs per year.”
The current pneumococcal vaccine, the 13-valent pneumococcal conjugate vaccine (PCV13, Prevnar 13), induces immune protection against thirteen subtypes of Streptococcus pneumoniae, the bacterium that causes pneumonia, meningitis, blood infections, ear infections, and other health problems. PCV13 replaced the previous 7-valent version, which protected against fewer subtypes, in 2010.
Use of the 13-valent pneumococcal vaccine subsequently reduced the rate of antibiotic-resistant invasive pneumococcal disease by 62 percent between 2009 to 2013 among children under the age of 5, a decrease of nearly two-thirds.
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Myth #1: You should fear Ebola more than the flu.
Myth #2: You don’t need the flu vaccine this year if you got it last year.
Myth #3: The flu shot is a “one size fits all” approach that doesn’t make sense for everyone.
Myth #4: The flu shot makes some people able to only walk backward.
Myth #5: Deaths from the flu are exaggerated.
Myth #6: The flu vaccine can give you the flu.
Myth #7: Flu vaccines contain dangerous ingredients, such as mercury, formaldehyde and antifreeze.
Myth #8: Pregnant women shouldn’t get the flu vaccine.
Myth #9: Flu vaccines can cause Alzheimer’s disease.
Myth #10: Pharmaceutical companies make a massive profit off flu vaccines.
Myth #11: Flu vaccines don’t work.
Myth #12: Flu vaccines don’t work for children.
Myth #13: Flu vaccines make it easier for people to catch pneumonia or other infectious diseases.
Myth #14: Flu vaccines cause heart problems and strokes.
Myth #15: Flu vaccines can damage a protective barrier between the blood and the brain in young children, hindering their development.
Myth #16: Flu vaccines cause narcolepsy.
Myth #17: The flu vaccine weakens your body’s immune response.
Myth #18: The flu vaccine causes nerve disorders such as Guillain-Barré syndrome.
Fact: Only the 1976 swine flu vaccine was linked to Guillain-Barré syndrome, and influenza is more likely to cause the nerve disorder than the flu vaccine; the CDC says those with the Guillain-Barré should consult a doctor before getting the flu shot.
Myth #19: The flu vaccine can cause neurological disorders.
Myth #20: Influenza isn’t that bad. Or, people recover quickly from it.
Myth #21: People don’t die from the flu unless they have another underlying condition already.
Myth #22: People with egg allergies can’t get vaccinated against flu.
Myth #23: If I get the flu, antibiotics will help me get better.
Myth #24: The flu shot doesn’t work for me, personally, because last time I got it, I got the flu anyway.
Myth #25: I never get the flu, so I don’t need the shot.
Myth #26: I can protect myself from the flu by eating right and washing my hands regularly.
Myth #27: It’s OK if I get the flu because it will make my immune system stronger.
Fact: Even if the flu in a future season resembles a strain you’ve had before, the protection is likely to be incomplete and fades over time. Flu weakens your immune system while your body is fighting it and puts others at risk.
Myth #28: If I do get the flu, I’ll just stay home so I’m not infecting others.
Myth #29: Making a new vaccine each year only makes influenza strains stronger.
Myth #30: The side effects of the flu shot are worse than the flu.
Fact: The most common side effects of the flu shot are mild, such as headache, fatigue, cough, low fever and arm soreness lasting a couple of days. Fewer than one in a million people experience severe allergic reactions.
Myth #31: The “stomach flu” is the flu.
Myth #32: If you haven’t gotten a flu shot by November, there’s no point in getting one.
TIME’s Science Cop Jeffrey Kluger takes on the misinformation coming from opponents of childhood vaccinations.
People from around the world will mark World Pneumonia Day on 12 November.
More than 1.5 million children die every year from pneumonia, more than from any other disease. But a million children’s lives a year could be saved by simple interventions such as vaccination against the most common causes of pneumonia and treatment with antibiotics.
For the first time in history, thanks to the GAVI Alliance partners, vaccines against the leading cause of pneumonia are reaching children in developing countries at nearly the same time they reach children in high income countries. This is unprecedented. The introduction of these vaccines is a cornerstone of GAVI’s ambitious plan to ensure that all children have equal access to life-saving vaccines.
The GAVI Alliance is a founder member of the Global Coalition against Child Pneumonia, formed in 2009 to raise awareness and to encourage governments to support the implementation of a range of proven measures to prevent and treat pneumonia.
Lesley Bunning does not mince words. The 62-year-old Sacramento-area woman nearly died of the flu earlier this year and has come forward with an important message. She says she was “a fool” not to get the flu vaccine in the past, and now she’s hoping to save lives by urging the public to get vaccinated this year and every year.