Vaccines, The History, The Myths | On Call with the Prairie Doc | November 22, 2018


>>THE DISCOVERY AND USE OF VACCINES HAS SAVED THE LIVES OF MILLIONS AND MILLIONS OF MEN, WOMEN AND CHILDREN. TEACHING OUR OWN IMMUNE SYSTEMS TO FIGHT DISEASE IS ONE OF THE MOST EFFECTIVE DEFENSES WE CAN HAVE. “VACCINES, THE HISTORY, THE MYTHS,” TONIGHT, “ON CALL WITH THE PRAIRIE DOC.”>>GOOD EVENING, AND WELCOME TO “ON CALL WITH THE PRAIRIE DOC.” TONIGHT WE VISIT A TOPIC OF GREAT IMPORTANCE, VACCINATIONS. IT IS HARD TO BELIEVE THAT IN 2019, WE HAVE TO COMBAT SCIENCE DENIERS WHEN IT COMES TO HEALTH. VACCINES HAVE PROVEN THEIR WORTH MILLIONS OF TIMES OVER, AND TONIGHT, WE WILL REVISIT THEIR SUCCESSES. FIRST, LET’S TAKE A LOOK AT THIS WEEK’S PRAIRIE DOC QUIZ QUESTION. PICK ONE. THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES OR THE ACIP’S FUNCTION IS TO: A, MAKE ALL VACCINES. B, RECOMMEND THE TYPE OF VACCINE AND THE AGE IT SHOULD BE GIVEN. C, INCLUDE ACTORS, LIKE JENNY MCCARTHY, ON ITS PANEL. D, ADVISE STATE HEALTH DEPARTMENTS ABOUT METHODS TO CLARIFY THE EFFECTIVENESS OF VACCINES. WE WILL HAVE THE CORRECT ANSWER AT THE END OF TONIGHT’S PROGRAM. JOINING US IN THE STUDIO DR. ARCHANA CHATTERJEE, CHAIR OF THE DEPARTMENT OF PEDIATRICS AT THE USD SANFORD SCHOOL OF MEDICINE. AND VIA SKYPE IS DR. JULIE GERBERDING, EXECUTIVE VICE PRESIDENT & CHIEF PATIENT OFFICER IN STRATEGIC COMMUNICATIONS, GLOBAL PUBLIC POLICY AND POPULATION HEALTH FOR MERCK & COMPANY, INC.>>THANK YOU BOTH FOR JOINING US.>>THANK YOU.>>I’M GOING TO START WITH YOU, ARCHIE. YOU ARE THE HEADS OF THE DEPARTMENT AT THE SCHOOL OF MEDICINE. TELL US A ALSO BUILT ABOUT WHAT THAT ROLE ENTAILS.>>WELL, IT’S AN ADMINISTRATIVE ROLE, PRIMARILY. AS CHAIR, I’M RESPONSIBLE FOR THE EDUCATION OF OUR MEDICAL STUDENTS IN THE FIELD OF PEDIATRICS. WE ALSO HAVE A PEDIATRIC RESIDENCY PROGRAM THAT WE HAVE A PROGRAM DIRECTOR, OF COURSE, BUT I OVERSEE THAT PROGRAM, AS WELL. AND THEN I HAVE A NUMBER OF FACULTY MEMBERS WHO DELIVER THE EDUCATION FOR THESE LEARNERS, AND THE MY RESPONSIBILITY TO HELP THEM WITH THEIR OWN CAREER DEVELOPMENT AND HELP MANAGER THEIR CAREERS, AS WELL.>>SO THEY’RE THE TEACHERS. BUT YOU ALSO HAVE MED STUDENTS THAT ARE ON THE WARDS OF PEDIATRIC HOSPITALS AND REGULAR HOSPITALS>>WELL, OUR CURRICULUM IS OUT-PATIENT-BASED, IN THE THIRD YEAR OF MEDICAL SCHOOL. WE DO HAVE STUDENTS IN THE CHILDREN’S HOSPITALS AND OTHER HOSPITALS IN PEDIATRIC UNITS ACROSS THE STATE. WE CALL THEM MINI BLOCKS, THEY SPENDS ABOUT A WEEK OF THE THIRD YEAR OF THEIR MEDICAL SCHOOL BUT THE REST OF THE TIME IS SPENT IN AN AMBULATORY SETTING IN THE CLINIC SETTING.>>WHERE VACCINATIONS OCCUR.>>ABSOLUTELY. AND YOU ARE CONVINCED THAT VACCINATIONS ARE EFFECTIVE>>I’M CONVINCED THAT VACCINATIONS ARE ONE OF THE MOST IMPORTANT THINGS THAT HAVE LED TO SAVING MILLIONS OF LIVES, REDUCING MORBIDITY, PREVENTING THE NEGATIVE EFFECTS OF DISEASES ACROSS THE GLOBE.>>AND JULIE, YOU ARE NO LONGER THE HEAD OF THE CENTER FOR DISEASE CONTROL BUT NOW IN CHARGE OF VACCINATIONS AT MERCK? COULD YOU EXPLAIN THAT A LITTLE BIT MORE?>>MY MAIN ROLE IS AS CHIEF PATIENT OFFICER TO REALLY STAND STRONG FOR WHAT PATIENTS NEED AND WANT FROM THEIR MEDICINES, THE SAFETY OF THEIR MEDICINES AND THE OVERALL ETHICAL ENVIRONMENT IN WHICH WE ADMINISTER THEM. BUT I HAVE A PASSION FOR VACCINES AND MERCK IS ONE OF THE FEW COMPANIES THAT STILL MAKES VACCINES SO WE WORK VERY HARD TO TRY TO IMPROVE THE GLOBAL AVAILABLE OF VACCINES BECAUSE WHILE WE CAN SOMETIMES TAKE THEM FOR GRANTED IN COUNTRIES LIKE THE UNITED STATES, THERE ARE PARTS OF THE WORLD WHERE PEOPLE ARE IS ABSOLUTELY DESPERATE TO BE VACCINATED AND PART OF OUR RESPONSIBILITY IS TO FIGURE OUT HOW CAN WE HELP THEM EVER THE SAME ADVANTAGES WE HAVE WITH THESE IMPORTANT MEDICINES.>>SO THE HISTORY OF VACCINE PROBABLY GOES BACK TO THE ORIGIN OF SMALLPOX, OR SMALLPOX WAS THE FIRST — WHERE PEOPLE WERE ACTUALLY KIND OF GIVING THEMSELVES OR HAVING DOCTORS GIVE THEM SMALLPOX ITSELF TO PREVENT THE ACCIDENTAL EXPOSURE TO LIMIT THE DISEASE. COULD WE TALK A LITTLE BIT ABOUT THE HISTORY OF SMALLPOX VACCINATIONS?>>SURE. IT’S A FASCINATING HISTORY, ACTUALLY, AND AS BEST WE CAN TELL IT PROBABLY GOES BACK TO WHAT YOU WERE REFERRING TO, WHICH IS TO TAKE A LITTLE BIT OF MATERIAL FROM ONE OF THE SMALLPOX LESIONS THAT A PATIENT HAD AND INOCULATE IT INTO A HEALTHY PERSON TO TRY TO HELP THEIR IMMUNE SYSTEM THEN DEVELOP IMMUNITY AGAINST SMALLPOX SO IF THEY WERE EXPOSED LATER ON TO SMALLPOX, THEY WOULD BE IMMUNE. THAT HISTORY WE THINK GOES BACK TO SOME PRACTICES IN CHINA. MOST PEOPLE DON’T REALIZE IT GOES THAT FAR BACK. AND THOSE PRACTICES THROUGH CERTAIN MECHANISMS, TRADE ROUTES, PROBABLY ENDED UP IN THE MIDDLE EAST, IN TURKEY AND THEN SOME OF THE MORE MODERN HISTORY OF VACCINATION THAT IS WE KNOW ABOUT OCCURRED IN PROBABLY THE 17th AND 18th CENTURIES. THOSE PRACTICES WERE TAKEN FROM THESE COUNTRIES, PARTICULARLY FROM TURKEY INTO ENGLAND AND FRANCE AND INTO THE WESTERN PARTS OF EUROPE AND WERE PRACTICED NOT JUST BY — PEOPLE WOULD JUST DO IT THEMSELVES. STORIES ABOUT FARMERS VACCINATING THEIR OWN FAMILIES, THAT KIND OF THING. AND OF COURSE IT WAS A VERY DANGEROUS THING TO DO. IF YOU GAVE SOMEONE TOO MUCH OR THEY HAD A SUPPRESSED IMMUNE SYSTEM, THAT PERSON COULD GETS SMALLPOX AND DIE.>>AND ALSO WHEN YOU DEVELOPED THE REACTION AND DEVELOPED A SMALL CASE OF SMALLPOX, YOU COULD PREYED IT TO SOMEBODY OR A YOUNG BAE->>IT WAS QUITE A DANGEROUS EXERCISE, SO BECAUSE PEOPLE WERE VERY AFRAID OF THIS DISEASE AND SMALLPOX EPIDEMICS OCCURRED, 60% OF THE POPULATION WOULD COME DOWN WITH IT AND 20% OF THE PEOPLE WHO WERE INFECTED WOULD ACTUALLY DIE. SO THIS HAD A TREMENDOUS IMPACT, A LOT OF PEOPLE WHO SURVIVED WOULD BE LEFT BLIND OR SCARRED AND HAD LONG-TERM, LIFETIME CONSEQUENCES FROM THIS, AND THIS WAS A DEADLY DISEASE AND PEOPLE WERE AFRAID OF IT. SO THEY WERE WILLING TO TAKE THIS RISKY MANEUVER AND TRY TO PREVENT IT FROM OCCURRING.>>THAT, OF COURSE, RIGHT NOW, WE TALK ABOUT SAFETY AND, JULIE, YOU’RE INVOLVED WITH TRYING TO MAKE SURE THAT WE’RE DOING THE SAFEST THINGS THAT WE CAN DO. SO THOSE — THAT TECHNIQUE WAS NOT THAT SAFE. I MEAN, QUITE RISKY. BUT THEN, ALONG COMES A RURAL PHYSICIAN, RIGHT? JULIE, TAKE THE STORY FROM THERE.>>WELL, THEN WE COME TO THE ERA OF LOUIS PASTEUR, WHO WE KIND OF THINK OF AS THE FATHER OF GERM THEORY BECAUSE HE REALLY WAS THE FIRST PERSON TO SCIENTIFICALLY UNDERSTAND THAT MANY INFECTIONS WERE CAUSED BY GERMS. SO HE WAS DEVELOPING VACCINES TO RABIES, WHICH WAS A DEADLY INFECTION AND QUITE COMMON AT THE TIME BUT HE ALSO WORKED ON ANTHRAX AND ULTIMATELY FIGURED OUT PASTEURIZATION, WHEREBY YOU COULD EITHER — OR REDUCE THE BACTERIA ACCOUNT [INDISCERNIBLE] AND, REALLY, IT’S MUCH SAFER WITH MILK AND OTHER PRODUCTS THAT WE TAKE FOR GRANTED TODAY.>>WOW, SO LOUIS BROUGHT WONDERFUL THINGS, THE RABIES STORY HAPPENED BUT THAT HAPPENED BEFORE JENNER, CORRECT?>>NO.>>OH.>>SO, EDWARD JENNER ACTUALLY PRECEDED LOUIS PASTEUR BY ALMOST A CENTURY. JENNER’S WORK ON VACCINATION, HE IS THE PERSON WHO COINED THE TERM, OCCURRED IN 1796. HE ACTUALLY PUBLISHED HIS FIRST PAPER IN 1796, IT WAS A SERIES OF CASES, 33 CASES, TO BE EXACT, WHERE HE HAD VACCINATED, NOT VIRULATED OR — BUT VACCINATED.>>WHAT’S THE DIFFERENCE?>>WHAT HE DID WAS TO SAY THIS BUSINESS OF TAKING THE MATERIAL FROM A SMALLPOX LESION IS REALLY RISKY, HE WAS A VERY GOOD EPIDEMIOLOGIST, ACTUALLY. HE NOTICED THAT THESE WOMEN WHO TOOK CARE OF COWS DIDN’T GET SMALLPOX AND THEY WERE EXPOSED TO A FORM OF POX, HE CALLED IT SMALLPOX OF COWS, WHICH WAS REALLY A DIFFERENT VIRUS, IT WAS A DIFFERENT VIRUS, BUT SOMEHOW IT PROTECTED THESE WOMEN FROM GETTING SMALLPOX AND, IN FACT, WHEN THERE WERE EPIDEMICS, THESE WERE THE WOMEN WHO WOULD COME TO NURSE PEOPLE BECAUSE THEY KNEW THEY COULDN’T CATCH IT. HE DECIDED HE WOULD TAKE THIS MATERIAL, ONE OF THE GIRLS, YOU KNOW, THEY WERE MILKMAIDS, THEY WOULD MILK THE COWS, THEY HAD THIS ON THEIR HANDS. THEY WOULD TAKE THE MATERIAL AND INOCULATE A LITTLE BOY, VACCINATE A LITTLE BOY, HIS GARDENER’S SON AND HE GAVE HIM THIS MATERIAL AND THEN HE WAITED A FEW WEEKS AND THEN HE DID THE EXPERIMENT THAT NO I.R.B. WILL LET US DO, NOWADAYS SHOULD NOT BE DONE, WHICH IS TO TAKE MATERIAL FROM A PATIENT WITH SMALLPOX AND INJECT IT INTO THE CHILD TO SEE IF THE CHILD WAS PROTECTED AND, OF COURSE, HE WAS. THEY DID IT A SECOND TIME. HE DIDN’T DO IT JUST ONCE, HE DID IT TWICE AND THE CHILD DID NOT COME DOWN WITH SMALLPOX SO HE PROVED HIS THEORY AND THIS WAS BEFORE THE GERM THEORY, BEFORE ANY UNDERSTANDING OF THE IMMUNE SYSTEM. I’M SIMPLY FROM OBSERVATION AND EXPERIMENTATION, WHICH IS HOW SCIENCE WAS DONE AT THE TIME.>>HE WAS A RURAL DOCTOR.>>HE WAS A COUNTRY DOCTOR, YES, A PRAIRIE DOC.>>A PRAIRIE DOC. I LOVE TO HEAR THAT, THANK YOU. WELL, THEN, THE STORY GOES, AFTER JENNER AND AFTER LOUIS, THERE WAS OTHER WORK, JULIE. I MEAN, I SUPPOSE THE NEXT BEST STORY IS THE POLIO STORY OR IS THERE ANOTHER STORY BEFORE THAT?>>THERE ARE MANY ATTEMPT AT VACCINES BUT I THINK THE POLIO STORY IS ONE OF THE MOST ASTONISHING STORIES. POLIO WAS A TERRIBLE DISEASE, ACROSS MUCH OF EUROPE AND THE UNITED STATES IN PART BECAUSE AS WE IMPROVED OUR SANITATION IN OUR CITIES, CHILDREN DID GET EXPOSED TO THE VIRUS ROUTINELY IN CHILDHOOD BUT OLDER PEOPLE CAME DOWN WITH POLIO AND OLDER YOU ARE WHEN YOU GET POLIO, THE MORE LIKELY YOU ARE TO BECOME PARALYZED, SO WE WERE EXPERIENCING URBAN OUTBREAKS OF PARALYTIC POLIO, AND IT WAS A TIME OF DESPERATE NEED FOR EXPERIMENTATION. SO, EARLY IN THE FIRST PART OF THE 1900s, A COUPLE OF VACCINES WERE CREATED AND TRIED BUT, UNFORTUNATELY, IN ONE CASE, THEY ENDED UP CAUSING POLIO AND IN SOME OTHER SITUATIONS THEY DIDN’T WORK VERY WELL. SO IT WASN’T UNTIL, REALLY, THE ’50s WHEN PEOPLE FIGURED OUT HOW TO CULTURE THE POLIO VIRUS IN CHICKEN EGGS THAT WE WERE ABLE TO TAKE ADVANTAGE OF THE EMERGING UNDERSTANDING OF VIRUSES AND ULTIMATELY CREATE THE KIND OF POLIO VACCINE THAT OLDER PEOPLE MIGHT REMEMBER TAKING IN SCHOOL, WHERE WHEN YOU WENT IN, YOU HAD TO SWALLOW A ALSO SUGAR CUBE THAT HAD A PINK DYE ON IT AND THAT WAS THE ORAL POLIO VACCINE. SOME PEOPLE ALSO RECEIVED THE SALT VACCINE, WHICH IS INJECTABLE VACCINE. THE OUTCOME OF ALL OF THAT IS TODAY IN THE WORLD, WE HAVE BEEN SO SUCCESSFUL WITH VACCINATING PEOPLE AGAINST POLIO THAT WE’RE QUITE CLOSE TO COMPLETELY ELIMINATING THE DISEASE. MOST COUNTRIES HAVE NO ACCESS CASES OF POLIO AND HAVE NOT SEEN POLIO IN A LONG, LONG TIME. UNFORTUNATELY, THERE ARE STILL SOME CORNERS OF THE WORLD WHERE BECAUSE THE WATER SANITATION IS POOR AND THE POLIO VIRUS CAN HIDE OUT THERE AND THE VACCINE PROGRAMS DON’T REACH ALL THE CHILDREN WHO NEEDS IMMUNIZATION, WHERE WE STILL SEE SOME OCCASIONAL OUTBREAKS. BUT WITH THE HELP OF THE UNITED NATIONS, THE CDC, THE ROTARY INTERNATIONAL AND A WHOLE NUMBER OF OTHER ORGANIZATIONS, THE WORLD IS BECOMING VERY, VERY CLOSE TO PUTTING POLIO ON THE SAME LIST THAT IT HAS BEEN ABLE TO PUT JENNER’S SMALLPOX ON AND THAT’S A DISEASE THAT ULTIMATELY CAN BE ERADICATED.>>WHEN I WAS, I THINK, SIX YEARS OF AGE, FIRST GRADE, MY MOTHER WAS FIRST IN THE LINE TO GET ME TO THAT — I THINK INITIALLY I HAD THE SHOT AND THEN THE NEXT YEAR I HAD THE SUGAR CUBE BECAUSE HER BROTHER HAD POLIO AND IT WAS, LIKE, FIVE-FOOT TALL BECAUSE OF IT, AND QUITE DISABLED AND DISABLED ALL OF HIS LIFE BECAUSE OF IT. I REMEMBER HER CRYING AT THE TIME, BRINGING ME TO THE DOCTOR TO GET THE VACCINE. WHAT A WONDERFUL TIME TO REALIZE THAT WE CAN SAVE OUR CHILDREN FROM THAT HORRIBLE DISEASE.>>YES. 1955 AND THE SALK VACCINE FIRST CAME OUT, IT WAS A GAME-CHANGER WHEN IT CAME TO THE NEXT ERA OF VACCINES.>>VACCINES COVER A WIDE BREADTH OF DISEASES. RECEIVING THEM AT THE PROPER AGE AND GETTING “BOOSTERS” AS NEED IS IMPORTANT TO MAINTAINING THE DESIRED EFFECT.>>WHAT’S HAPPENING IN MUCH OF THE REST OF THE COUNTRY ARE ANTIBIOTICS ARE LOSING EFFECTIVENESS AS YOU’VE MENTIONED AND THAT’S DUE TO THE OVERUSE OF ANTIBIOTICS AND THE OVERVIEWS OF CERTAIN TYPES OF ANTIBIOTICS. IN THE EARLY 2000s, WHAT WE NOTICED WAS THE OLDER ANTI BOSS WAS JUST AS EFFECTIVE AND NOT CAUSING THOSE TYPES OF PROBLEMS, SO THINGS LIKE PENICILLIN, WHEN YOU PROVE THERE IS AN INFECTION THAT NEEDS TREATMENT ARE VERY EFFECTIVE AND DON’T TENDS TO DRIVE THE BACTERIA TO CREATE RESISTANCE, MUCH LIKE SOME OF THE NEWER ANTIBIOTICS DO.>>LIKE LEVAQUIN AND –>>WE LABELED THEM BROAD SPECTRUM ANTIBIOTICS MEANING THAT THEY KILL A LOT OF DIFFERENT TYPES OF BACTERIA AND THE STRATEGY WAS, IF WE USE THOSE, THEN WE DON’T NEED TO REALLY IDENTIFY WHAT WE’RE DEALING WITH BECAUSE WE’RE COVERING ALL THE BASES. NOW, WHAT THAT STRATEGY HAS LED TO IS DAMAGING OUR OWN PROTECTIVE BACTERIA AND LEADING TO BACTERIAL RESISTANCE IN INFECTIONS WHERE THERE’S NO ANTIBIOTIC EFFECTIVENESS ANYMORE.>>I REMEMBER YOU TELL THE STORY IN, LIKE, 2000, IN BROOKINGS IN OUR CONFERENCE ROOM, THAT YOU HAD SAID TO THE PEOPLE TREATING URINARY TRACT INFECTIONS PARTICULARLY, THAT YOU COULDN’T USE LEVAQUIN OR COULDN’T USE CIPRO FOR URINARY TRACT INFECTION UNLESS AN INFECTIOUS DISEASE PERSON WAS CONSULTED SO THEY HAD TO USE THE OLD ANTIBIOTICS. AND WHAT HAPPENED AT THAT TIME?>>WHAT WE DID WAS WE TALKED WITH ALL OUR MEDICAL STAFF AND OUR PROVIDERS, PRACTITIONERS, AND P.A.s AND PHARMACISTS AND SO FOR THE BACK IN EARLY 2000s AND LAID OUT THE SCIENTIFIC CASE IN THE LITERATURE AND SAID IF QUESTIONS CAME UP AS TO WHAT ANTIBIOTICS TO USE, CONTACT ME AND WE COULD TALK THROUGH IT BASED ON WHAT THE SENSITIVITIES OF THE BACTERIA WERE OF OUR REGION. THE HUGE ADVANTAGE THAT WE HAVE THIS A RURAL AREA IS WE HAVE ONE MICROBIOLOGY LAB THAT TELLS US WHEN WE USE DIFFERENT ANTIBIOTICS WHAT HAPPENS IN OUR REGION. SO WE WERE SEEING INCREASING RESISTANCE, MUCH LIKE THE REST OF THE COUNTRY, THAT WE MADE THE CHANGES AND STARTED SHOWING A DECREASED RESISTANCE. SO OUR GOAL IN 2000 WAS TO KEEP OUR ANTIBIOTICS JUST AS EFFECTIVE FOR US IN 2010 AND WE HIT THAT GOAL. NOW THE GOAL IS CAN WE KEEP OUR ANTIBIOTICS JUST AS EFFECTIVE IN 2020 AS THEY WERE IN 2000, AND WE’RE ON TRACK TO DO THAT, AS WELL.>>SOME REMEMBER YOU SAYING THAT THE TWO BIG BUGS THAT WERE BAD ARE THE M.R.S.A., COMMONLY CALLED — WHAT IS IT CALLED, IT’S CALLED THE MEGABUG –>>SUPER BUG. THE METHACILLIN-RESISTANT AND ENTEROBACTER?>>ENTEROBACTER AND SEVERAL OTHERS.>>THE DIARRHEA THAT COMES AFTER AN ANTIBIOTIC.>>EXACTLY. THERE ARE CERTAIN TYPES OF ANTIBIOTICS, MAINLY.>>ALL RIGHT. SO WHAT HAPPENED WHEN YOU MADE THOSE CHANGES IN RAPID CITY?>>OUR RATE OF MRSA WAS ABOUT NATIONAL AVERAGE.>>LIKE 20%, 30% –>>BACK THEN, IT WOULD HAVE BEEN ABOUT 50% AND SO THAT CAME DOWN TO 35% AND IT WAS THE FIRST TIME IN THE COUNTRY THAT IT HAD BEEN REPORTED THAT YOU COULD ACTUALLY LOWER THAT WITH THE WAY YOU USED ANTIBIOTICS SO WHAT IT IS NOW IS 31%, WHICH IS ABOUT HALF THE NATIONAL AVERAGE AND THE REASON THAT’S IMPORTANT IS IF YOU HAVE A RESISTANT STAPH INFECTION, MRSA IN THE BLOOD AS OPPOSED TO SENSITIVE STAPH, A DIFFERENT PATTERN OF ANTIBIOTICS YOU CAN USE, YOU HAVE HALF THE MORTALITY RISK. HALF DEATH RATE.>>HALF THE DEATH RATE. SO IF YOU CAN STEWARD THE BACTERIA BACK TO BEING MORE SENSITIVE BY THE WAY YOU USE ANTIBIOTICS, THEN YOU’RE SAVING LIVES.>>WOW. AND THE SAME THING HAPPENED — I THINK YOU SAID THE ENTEROBACTOR WENT TO 0 FROM 30%.>>WE HAD TWO THAT ARE VERY EFFECTIVE, ONE WAS ENTEROCOCCUS THAT HAD BECOME RESISTANT TO VANCOMYCIN, THAT HAD BEEN 20-30%, YOU HAVE A GOOD MEMORY, AND DROPPED TO 0.>>YOU REPEATED THE STORY SO MANY TIMES. AND THEN THE C-DIF HAS CREATED A VERY DANGEROUS SITUATION WHERE 10% OF THE PEOPLE OVER 65 ACTUALLY DIE FROM THAT INFECTION. WE DON’T HAVE THAT STRAIN IN MUCH OF SOUTH DAKOTA BECAUSE WE HAVE WE’VE USED ANTIBIOTICS IN A WAY THAT DOESN’T PROMOTE THAT.>>SO YOU’VE DONE REALLY WELL IN RAPID CITY BUT WHAT ABOUT STATE OF SOUTH DAKOTA? I MEAN, DO YOU THINK IT’S BECAUSE OF YOUR EFFORT? I THINK IT IS.>>WELL, WE’VE BEEN ACCUSED THAT THE MAGICAL PROPERTIES OF THE MISSOURI RIVER HAD SOME BENEFIT BUT WE ACTUALLY HAVE WORKED WITH A COUPLE SMALLER COMMUNITIES AND WE REALLY ENJOY WORKING WITH THE RURAL HOSPITALS BECAUSE THEY ARE SO EFFECTIVE AT GETTING THINGS DONE. THERE IS A LOT LESS BUREAUCRACY AND SO FORTH AND WE’VE WORKED WITH A COUPLE SMALLER HOSPITALS IN THE EASTERN SIDE OF THE STATE AND ABLE TO REPLICATE THE RAPID CITY MODEL IN THOSE HOSPITALS AND THEY’VE DRAMATICALLY DECREASED THEIR ANTIBIOTIC USE AND AMOUNT OF RESISTANT BACTERIA, AS WELL. MUSIC Dr. KEEGAN AN INFECTIOUS DISEASE SPECIALIST IN RAPID CITY HAS BEEN A LONGTIME HERO HAVE OH MINE. PART OF HIS WHOLE STORY IS ANTIBIOTIC STEWARDSHIP, AND SO I THANK HIM FOR THAT NICE ROLL-IN. WE’RE TALKING ABOUT POLIO AND THE EXPERIENCE. I GAVE YOU MY MOTHER’S EXPERIENCE. THERE ARE A LOT OF PEOPLE WHO ARE ALIVE TODAY THAT HAVE NEVER HEARD OF POLIO, NEVER HEARD OF SMALLPOX AND THEY DON’T REALLY BELIEVE THAT IT’S A REAL THREAT OR THAT IT WAS A REAL THREAT. WHAT’S YOUR THOUGHT ON THAT?>>WELL, THEY MIGHT HAVE HEARD OF SMALLPOX OR POLIO BUT THEY THINK THESE DISEASES ARE GONE, WHICH IS TRUE IN THE CASE OF SMALLPOX, THAT THERE IS NO SMALLPOX ANYWHERE IN THE WORLD ANYMORE BUT IT’S NOT TRUE FOR POLIO. WHILE WE’RE VERY CLOSE TO ERADICATION, AS Dr. GERBERDING TALKED ABOUT, WE AREN’T THERE YET AND POLIO WAS ONE OF THE DISEASES THAT WAS DREADED IN THE 20th CENTURY. SO IN 1952, THERE WAS THIS OUTBREAK THAT HAPPENED AND THERE WERE ABOUT 60,000 CASES OF POLIO THAT WERE REPORTED, AT THE TIME THERE WERE CLOSE TO 3,000 DEATHS. PEOPLE DON’T REALIZE THAT PEOPLE ACTUALLY DIED OF POLIO AND ALMOST 20,000 PEOPLE WHO WERE PARALYZED BECAUSE OF THIS INFECTION.>>RIGHT.>>SO THIS DISEASE HAD A TREMENDOUS IMPACT AND PEOPLE LIKE YOUR MOTHER WERE VERY AFRAID BECAUSE THEY’D HAD FAMILY MEMBERS WHO WERE IMPACTED AND THEY DIDN’T WANT THEIR CHILDREN TO GET THIS DISEASE.>>SO THEY’RE HAVING THIS KIND OF 60,000 PEOPLE COMING DOWN WITH THIS ILLNESS IN 1953, ’54, ’55, THEN WHAT HAPPENED?>>SO AFTER THAT EPIDEMIC HAPPENED, THERE WAS WORK, AS Dr. GERBERDING MENTIONED, ABOUT WORKING ON DIFFERENT TYPES OF POLIO VACCINE HAVE THE THAT WORK HAD BEEN GOING ON. ONE OF THE BREAK-THROUGHS WAS THE ABILITY TO GROW THE VIRUS IN CULTURE AND THEN THEY WERE ABLE TO MANIPULATE THAT VIRUS AND KILL IT AND THE ORIGINAL VACCINE, THE SALK VACCINE WAS A KILL VACCINE, THE INJECTABLE VACCINE THAT WAS DEVELOPED. THERE WERE BIG FIELD TRIALS, HUNDREDS OF THOUSANDS OF CHILDREN WHO WERE INVOLVED IN THE FIELD TRIAL AND PEOPLE WERE LINING UP TO GET INTO THE CLINICAL TRIAL BECAUSE THEY KNEW THEY HAD A CHANCE OF GETTING THE VACCINE, AND THEN IT WAS LICENSED VERY QUICKLY AND IN 1955, IT BEGAN TO BE MADE AVAILABLE TO THE POPULATION AT LARGE.>>AND WHAT HAPPENED TO THE POPULATION AT LARGE, JULIE? WHAT HAPPENED WITH THE DISEASE?>>WELL, OVER THE NEXT DECADE, WE REALLY DID SEE A DRAMATIC REDUCTION IN THE INCIDENCE OF POLIO SO THAT WHERE WE ARE TODAY, IN THE DEVELOPMENT OF THE VACCINE IS FINALLY AVAILABLE, I DON’T THINK VERY MANY INFECTIOUS DISEASE DOCTORS HAVE EVER SEEN A CASE OF POLIO. I TRAVEL INTERNATIONALLY AND UNFORTUNATELY I HAVE SEEN POLIO AND I’VE SEEN THE CHILDREN WHO ARE DISABLED, IN FACT, I REMEMBER ONE LOVELY LITTLE GIRL IN INDIA WHO HAD A SEVERE DEFORMITY OF YOUR LEG AND HAS A GREAT DEAL OF TROUBLE WALKING AND I ASKED HER WHAT DO YOU WANT TO BE WHEN YOU GROW UP, AND SHE SAID, I WANT TO BE A DOCTOR AND TAKE CARE OF CHILDREN WHO NEED VACCINES SO THAT NO CHILD EVER HAS TO SUFFER THE WAY I SUFFERED.>>WOW.>>WHEN YOU HEAR SOMETHING LIKE THAT, IT’S IN YOUR HEART FOREVER AND IT MAKES YOU FEEL INCREDIBLY PASSIONATE ABOUT TRYING TO IMPROVE THE GLOBAL ACCESS TO THE LIFE-SAVING AND HEALTH PROTECTING MEDICATIONS.>>WELL, PEOPLE SAY THAT THOSE ILLNESSES ARE NO LONGER A THREAT AND SO WE REALLY DON’T NEED TO WORRY ABOUT THEM, AND THE — BUT THERE IS A QUESTION ABOUT VACCINATIONS OUT THERE. I MEAN, THERE’S THIS FEAR OF VACCINATION, AND IT CAME — A LOT OF IT CAME OUT OF THE M.M.R. VACCINATION THAT CHILDREN HAVE, AND A RESEARCHER FROM ENGLAND. WHAT’S THAT STORY, ARCHIE?>>SO, THAT STORY TAKES US INTO THE LATE 1990s. THERE WAS A GASTROENTEROLOGIST OF ALL PEOPLE –>>NOT INFECTIOUS DISEASE –>>NOT INFECTIOUS EXPERT, NOT A PRIMARY CARE DOCTOR, WHO NOTICED, HE SAYS, THAT SOME OF HIS PATIENTS WHO HAD RECEIVED THE M.M.R. VACCINE THEN WERE DIAGNOSED WITH AUTISM AND HE PUBLISHED THIS PAPER ALONG WITH SEVERAL CO-AUTHORS, 12 OR 13 CO-AUTHORS, IT WAS PUBLISHED IN THE BRITISH JOURNAL, “LANCET,” AND IT SET OFF A FIRESTORM BECAUSE, SUDDENLY PEOPLE WERE CONCERNED THAT THE M.M.R. VACCINE SOMEHOW HAD CAUSED THE DIAGNOSIS OF AUTISM IN THESE CHILDREN. IT WAS A VERY SMALL GROUP OF CHILDREN, 12 CHILDREN THAT WERE IN THE STUDY. LATER ON, IT WAS DISCOVERED THAT THERE WERE MANY MISSTEPS IN THE WAY THAT THE STUDY WAS DONE, IN THE WAY IT WAS REPORTED. THERE WERE AT LEAST 22 STUDIES LAUNCHED ACROS THE WORLD TO SEE IF THERE WAS ANY TRUTH TO THIS ASSOCIATION AND NO ONE ELSE COULD REPLICATE THIS RESULT. AND SO THEN PEOPLE BEGAN INVESTIGATING HOW THAT STUDY HAD BEEN DONE AND HOW THOSE RESULTS HAD BEEN ACHIEVED AND, LONG STORY SHORT, WHAT HAPPENED WAS THEY FOUND OUT THAT THIS WAS A FRAUDULENT THING THAT HAD OCCURRED. THE “LANCET” BECAME CONVINCED THAT THEY PUBLISHED SOMETHING THEY OUGHT NOT TO HAVE, AND THEY WITHDREW THE PAPER. AS YOU KNOW, THEY DON’T WITHDRAW MANY PAPERS. IF YOU LOOK FOR THE ORIGINAL PAPER, YOU CAN’T FIND IT ANYMORE, IT’S GONE. BUT UNFORTUNATELY THAT MYTH HAS TAKEN ROOT IN PEOPLE’S MINDS AND WE CONTINUE TO HEAR ABOUT CONCERNS BETWEEN M.M.R. VACCINES AND AUTISM, AND IT’S JUST NOT TRUE.>>IT’S JUST NOT TRUE. MAYBE PART OF THE REASON THAT PEOPLE THINK THAT IS BECAUSE THE DEVELOPMENT OF AUTISM IS FIRST VIEWABLE AT AN AGE WHEN A CHILD IS ALSO GETTING ROUTINE VACCINES.>>ABSOLUTELY. CHILDREN ARE RECEIVING MULTIPLE VACCINES IN THEIR FIRST TWO YEARS OF LIFE AND OFTEN THE DIAGNOSIS OF AUTISM IS MADE RIGHT AROUND THAT TWO- TO THREE-YEAR TIME FRAME SO IT’S VERY COMMON FOR PEOPLE TO SAY I GOT MY CHILD VACCINATED, NOW THEY’RE DIAGNOSED WITH AUTISM AND I THINK THERE IS A CORRELATION.>>AND I THINK THOSE CHILDREN HAD ALSO BEEN EXPOSED TO MILK, MAYBE THE MILK WAS THE CAUSE OF THE AUTISM. THAT’S A JOKE. JULIE, WHAT’S YOUR TAKE ON THIS WHOLE STORY OF FEAR OF VACCINATION?>>YOU KNOW, WE ARE LIVING IN AN EPIDEMIC OF THAT KIND OF FEAR AND THE CONSEQUENCES ARE NOT TRIVIAL. AS WE SPEAK TODAY, WE’RE EXPERIENCING SOME INCREASE IN MEASLES ACROSS THE UNITED STATES, MEASLES IN THE U.K.. I WAS IN THE BALKANS A FEW MONTHS AGO AND THEY’RE HAVING A HUGE OUTBREAK OF MEASLES, WITH ENCEPHALITIS, WITH CHILDREN WHO WILL BE PERMANENTLY DAMAGED FROM EXPOSURE TO A DISEASE THAT IS PREVENTABLE WITH A SIMPLE VACCINE, BUT WHICH THE CHILDREN DID NOT GET BECAUSE OF PEOPLE’S HESITATION ABOUT THE SAFETY OF THE PRODUCT. AND I THINK THAT CONCEPT OF HESITANCY IS ONE THAT IS ON EVERY PARENTS’ MIND AND IF YOU HAVEN’T SEEN THE DISEASE, IT IS VERY DIFFICULT SOMETIMES TO THINK, IF THERE’S ANY POSSIBLE HARM FROM THE VACCINE AND YOU DON’T KNOW ANYONE WHO’S EVER HAD MEASLES OR MUMPS OR RUBELLA, ARE YOU REALLY PROTECTING YOUR CHILD. AND I THINK THAT’S WHERE IT’S SO IMPORTANT FOR PEDIATRICIANS TO BE VERY CANDID WITH MOMS AND DADS ABOUT WHY VACCINES IS SO IMPORTANT AND WHAT HAPPENS IN THE COMMUNITY IF CHILDREN ARE NOT VACCINATED. MEASLES IS ONE OF THE MOST INFECTIOUS DISEASES WE KNOW. IT TAKES A WHIFF OF EXPOSURE TO INOCULATE A WHOLE CLASSROOM FULL OF CHILDREN AND IT’S THE LEVEL OF PROTECTION IN THOSE STUDENTS FALLS BELOW THE LEVEL NEEDED TO PROTECT THE WHOLE CLASS ROOM, THEN YOU SEE CHILDREN INVOLVED IN OUTBREAKS AND WE END UP WITH CHILDREN IN THE HOSPITAL AND THIS SEVERE AND SOMETIMES FATAL COMPLICATIONS WITH MEASLES. IT’S NOT THEORETICAL, EVEN IN THE UNITED STATES. IT’S HAPPENED, IT HAPPENED IN DISNEYLAND, IT HAPPENS SOMETIMES WHEN CHILDREN FROM OTHER COUNTRIES WHO AREN’T VACCINATED FLY IN AND THEN EXPOSE A CLASSROOM FULL OF POORLY IMMUNIZED CHILDREN AND, YOU KNOW, THE FACT THAT WE’RE DEALING WITH MEASLES OUTBREAKS IN 2018, 2019, THIS IS JUST NOT SOMETHING THAT WE IN THE PUBLIC HEALTH COMMUNITY CAN TOLERATE. WE HAVE TO STAND STRONG ON THE IMPORTANCE OF PROTECTING ALL ALL OF OUR CHILDREN.>>YEAH. ARCHIE, TALK ABOUT — IT’S CHILLING TO THINK ABOUT THAT. TAKE — EXPLAIN TO THE AUDIENCE THE SYMPTOMS AND THE COMPLICATIONS OF MEASLES, MUMPS AND RUBELLA. AND THEN WE NEED TO TALK ABOUT THE SIDE EFFECTS OF THE VACCINE, WHAT WE KNOW ABOUT IT.>>RIGHT. SO THE THREE DISEASES THAT WE LUMP IN TOGETHER MOSTLY BECAUSE WE HAVE A VACCINE WHICH CONTAINS ALL THREE VIRUSES, ARE VERY DIFFERENT INFECTIONS. MEASLES IS PROBABLY THE DEADLIEST OF THE THREE. IT WAS A MAJOR KILLER OF CHILDREN BEFORE WE HAD AN EFFECTIVE VACCINE FOR IT AND EVEN IN CHILDREN WHO SURVIVED, THERE WOULD BE MANY CHILDREN WHO WOULD BE LEFT BLIND, WHO WOULD HAVE OTHER CONSEQUENCES OF HAVING HAD THIS SEVERE CHILDHOOD ILLNESS. WITH MUMPS, MOST PEOPLE KNOW IT CAUSES A SWELLING OF THE FACE, IT CAN AFFECT ALL THE SALIVARY GLANDS AND IT CAN AFFECT OTHER GLANDS IN THE BODY –>>TESTICLES.>>THAT IS CORRECT. AND ONE OF THE MOST COMMON CONSEQUENCES OF MUMPS ACTUALLY WAS DEAFNESS AND ALSO INFERTILITY. SO PEOPLE DON’T KNOW ABOUT THOSE THINGS BECAUSE THEY DON’T SEE MUCH MUMPS ANYMORE, AND THEN RUBELLA, OR SOME PEOPLE CALL THE THE GERMAN MEASLES OR PEOPLE CALL MEASLES THE HARD MEASLES AND THIS WAS, YOU KNOW, NOT SO SEVERE, THE RUBELLA DISEASE IS THE MOST DIFFICULT, ACTUALLY, TO DIAGNOSE CLINICALLY BECAUSE THE RASH IS PRETTY MILD. MOST CHILDREN ACTUALLY NOT THAT SICK WITH RUBELLA. WHERE RUBELLA CAUSES MOST OF THE PROBLEMS IS IF THERE IS A PREGNANT WOMAN WHO BECOMES INFECTED AND IS NOT IMMUNE TO RUBELLA, THERE IS A ONE IN FOUR CHANCE THAT HER BABY WILL HAVE WHAT WE CALL CONGENITAL RUBELLA SYNDROME AND THAT’S A SYNDROME SO THAT INCLUDES LOTS OF PARTS OF THE BODIES BEING INFECTED, DEAFNESS, HEART PROBLEMS, MULTIPLE DIFFERENT PROBLEMS, COGNITIVE DEFECTS, ALL THOSE KINDS OF THINGS, AND THIS WAS A REAL ISSUE EVEN AS RECENTLY AS IN THE ’80s AND ’90s HERE IN THE U.S., BECAUSE WE HAD CONTROLLED RUBELLA THROUGH THE M.M.R. VACCINE BUT WE WERE GETTING IMMIGRANTS FROM OTHER COUNTRIES WHERE THEY WERE STILL USING ON THE MEASLES, NOT USING THE M.M.R. VACCINE. NOW ACROSS THE WORLD, ALMOST EVERY COUNTRY USES THE M.M.R. VACCINE.>>I DO KNOW THERE ARE IMMIGRANT POPULATIONS IN PARTICULAR WHO ARE FRIGHTENED OF THE M.M.R. AND ALL VACCINATIONS AND LEAD US TO GREATEST CONCERN BECAUSE WE LOSE OUR HERD IMMUNITY WHEN THAT HAPPENS.>>SO AN UNFORTUNATE STORY HERE, THIS HAPPENED A COUPLE OF YEARS AGO IN MINNESOTA, IN MINNEAPOLIS, AS YOU KNOW, THERE IS A SOMALI POPULATION AND OUR OLD FRIEND, ANDREW WAKEFIELD, SHOWED UP THERE AND CONVINCED THESE FAMILIES THAT VACCINES WERE HARMFUL TO THEIR CHILDREN AND THEY BEGAN TO REFUSE VACCINATIONS. A POPULATION THAT HAD BEEN VERY HIGHLY VACCINATED, BECAUSE THEY CAME FROM A COUNTRY WHERE MEASLES WAS ENDEMIC. NEEDS SEEN THE DISEASE, THEY WERE VACCINATING THE CHILDREN. THEY BECAME FRIGHTENED AND STOPPED VACCINATING THE CHILDREN. THERE WAS A HUGE OUTBREAK THAT HAPPENED, THANKFULLY THERE WERE NO DEATHS THAT OCCURRED. THE MINNEAPOLIS CHILDREN’S HOSPITAL ADMITTED A NUMBER OF THESE CHILDREN AND WERE ABLE TO TAKE CARE OF THEM SO THAT THESE CHILDREN SURVIVED BUT THERE WAS THIS HUGE OUTBREAK BECAUSE OF MISINFORMATION.>>MISINFORMATION.>>THE NEED FOR VACCINATIONS IS UNIVERSAL. HOWEVER, THERE MAY BE THE NEED FOR A GREATER EMPHASIS ON CERTAIN VACCINATIONS DEPENDENT ON GEOGRAPHIC LOCATION.>>SOUTH DAKOTANS DO REMARKABLY WELL. WE’RE USUALLY NUMBER ONE OR TWO IN THE NATION FOR THE 2016-2017 FLU SEASON, WHICH IS THE MOST UP-TO-DATE INFORMATION THAT WE HAVE, SOUTH DAKOTANS RANKED NUMBER 2. WE FELL A SPOT BEHIND RHODE ISLAND BUT I’M HOPING THAT FOR 2017, 2018 FLU SEASON WE’LL BE BACK TO NUMBER ONE. SO THERE ARE OTHER VACCINES THAT ARE SPECIFICALLY DESIGNED FOR THE OLDER POPULATION, INDIVIDUALS 65 YEARS OF AGE AND OLDER. THAT INCLUDES SEVERAL DIFFERENT VACCINES, THE HIGH-DOSE FLUZONE, IT INCLUDES A TRIVALENT FLU VACCINE AND ALSO A RECOMBINANT VACCINE THAT IS AVAILABLE, AS WELL. I WOULD DEFINITELY RECOMMEND ONE OF THOSE THREE VACCINES OVER JUST THE TRIVALENT VACCINE THAT’S OUT THERE. IN KIDS UNDER 2 YEARS OF AGE, THE PNEUMOCOCCAL VACCINATION IS VERY IMPORTANT. MOST OF THE KIDS AT THAT AGE ARE AT RISK OF COME DOWN WITH SOME CONDITION, WHETHER AN EAR INFECTION OR SO ON. THOSE WHO ARE AGE 65 YEARS OF AGE AND OLDER TYPICALLY HAVE MORE SEVERE SYMPTOMS WHEN THEY DO BECOME SICK WITH VACCINE BUT THAT IS WHY THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES DOES RECOMMEND BOTH VACCINATION OF CHILDREN LESS THAN TWO YEARS OF AGE AS WELL AS INDIVIDUALS AGE 65 YEARS AND OLDER. IN ORDER FOR INDIVIDUALS TO GO INTO OUR INSTITUTIONS, IT’S VERY IMPORTANT THAT WE PROTECT EVERYONE THAT’S IN THAT INSTITUTION, SCHOOLS ALIKE. SO WE DO HAVE ENTRY REQUIREMENTS FOR DIFFERENT VACCINES, THAT INCLUDES THE DIPTHERIA, TETANUS AND PERTUSSES, THE MEASLES, MUMPS AND RUBELLA VACCINE, M.M.R. VACCINE, AS WELL AS VERASELLA, AS WELL AS THE POLIO VACCINE THAT IS REQUIRED. THERE ARE CERTAIN RECOMMENDATIONS THAT — FOR INDIVIDUALS NOT TO RECEIVE VACCINE AND THOSE ARE SPECIFICALLY LAID OUT IN THE CHILDHOOD IMMUNIZATION SCHEDULE. SO INDIVIDUALS WHO MAY THINK THEY HAVE A DISQUALIFYING CONDITION CAN DEFINITELY SEEK THAT OUT, SPEAK WITH THEIR HEALTH CARE PROVIDER AND THEIR HEALTH CARE PROVIDER CAN DEFINITELY HELP THEM FIGURE OUT WHETHER THEY WOULD NEED TO DELAY OR NOT GET ANY OF THE VACCINES THAT ARE RECOMMENDED. MUSIC>>WELL, I THINK THAT THIS WHOLE STORY OF THE AUTISM FEAR AND THE MYTH THAT SOMETHING IS HARMFUL WITH VACCINATIONS IS A REAL FEAR OUT THERE. PEOPLE TALK ABOUT THE SIDE EFFECTS OF VACCINATIONS. THERE ARE SIDE EFFECTS OF VACCINATIONS. JULIE, COULD YOU TALK ABOUT THE POTENTIAL REAL SIDE EFFECTS THAT SOME PEOPLE HAVE WITH THE VACCINATIONS WE’RE GIVING NOW IN THE U.S.?>>SO, THERE ARE SIDE EFFECTS FROM EVERY MEDICAL INTERVENTION THAT WE ALL KNOW, IN THE MEDICAL PROFESSION, SO OF COURSE THERE ARE VACCINE SIGH EFFECTS. THE COMMON THINGS THAT OCCUR FOLLOWING PEDIATRIC IMMUNIZATIONS ARE LOCAL PAIN, OF COURSE GETTING A SHOT CAN CREATE SOME TENDERNESS AND SWELLING AND SOMETIMES EXAGGERATED LOCAL REACTIONS. CHILDREN OFTEN HAVE FEVERS FOLLOWING IMMUNIZATIONS. THESE ARE EXPECTED SIDE EFFECTS AND KIND OF THE THINGS THAT ARE ACTUALLY MANAGED WITH SIMPLE HOME REMEDIES. THERE ARE MORE SERIOUS SIDE EFFECTS THAT CAN OCCUR SO IT’S IMPORTANT TO MAINTAIN VIGILANCE ABOUT THIS. A NUMBER OF YEARS AGO, A NEW VACCINE FOR DIARRHEA WAS INTRODUCED AND I THINK THAT GAVE ME A LOT OF CONFIDENCE THAT WHEN A SERIOUS SIDE EFFECT DID EMERGE, ONLY A FEW CASES OF THE COMPLICATION OF BASICALLY OBSTRUCTION IN THE INTESTINAL TRACT OF YOUNG CHILDREN, THE CDC WAS ABLE TO GET A VERY EARLY SIGNAL THAT THERE COULD BE A PROBLEM AND ULTIMATELY THAT VACCINE WAS TAKEN OFF THE MARKET, JUST ON THE BASIS OF A FEW CASES OF THIS INTESTINAL BLOCKAGE. SO WE HAVE HIM SENSITIVE SYSTEMS FOR DETECTING UNUSUAL AND SERIOUS SIDE EFFECTS AND BECAUSE WE’RE PUTTING VACCINES IN THE HEALTHIEST AND THE MOST VULNERABLE OF OUR POPULATION, OUR INFANTS AND CHILDREN, WE HAVE TO HAVE AN EXTREMELY CAREFUL VIGILANCE FOR BEING ON THE LOOKOUT FOR ANYTHING THAT COULD POTENTIALLY SIGNIFICANT A SIGNAL A PROBLEM. I HAVE CONFIDENCE IN OUR ABILITY TO DO THAT. I KNOW I SPEAK FOR ALL WHEN WE SAY WHEN WE GET REMARKS ABOUT A VACCINE, WE TAKE IT VERY SERIOUSLY, IT GETS REPORTED TO THE FDA. WE’RE ALL OVER IT BECAUSE WE KNOW WHAT’S AT STAKE.>>SAFETY IS A REAL ISSUE AND I THINK WE — WE’VE HEARD JULIE’S COMMENTS ABOUT THE SAFETY IS VERY HIGH BUT — AND THAT THERE ARE SOME SIDE EFFECTS AND WE HAVE TO REALIZE THERE IS A SMALL AMOUNT OF RISK BUT A HUGE AMOUNT OF GAIN.>>ABSOLUTELY.>>I RECENTLY READ AN ARTICLE ABOUT DENGUE FEVER AND THE RISK TO THE CHILDREN. I THROW THIS BACK AT JULIE BECAUSE YOU’RE MORE USED TO FOREIGN-LAND VACCINATIONS WHEN YOU WERE IN THE C.D.C., AND DENGUE FEVER WAS IN CERTAIN PLACES A MAJOR ILLNESS. ANY COMMENTS ABOUT THE ADVANTAGES AND THE DISADVANTAGES OF DENGUE FEVER VACCINE?>>YOU KNOW, DENGUE IS ONE OF THOSE INFECTIOUS DISEASE LIKE ZIKA OR WEST NILE VIRUS THAT ARE TRANSFERRED FROM MOSQUITOES, TENDS TO BE VERY COMMON IN PARTS OF ASIA AND SOUTH AMERICA SO IT WAS REALLY A BREAK-THROUGH WHEN ONE OF THE VACCINE MANUFACTURERS WAS ABLE TO BRING FORWARD A DENGUE VACCINE. BUT THAT’S A TRICKY DISEASE. WHEN YOU GET IT THE FIRST TIME, YOU GET A MILD ILLNESS. SOMETIMES, IF YOU GET IT AGAIN, YOU GET A VERY SERIOUS KIND OF HYPER REACTION TO IT AND IT TURNS OUT THERE ARE REPORTS IN THE PHILIPPINES WHERE THE VACCINE WAS USED AS A PUBLIC HEALTH INTERVENTION THAT SOME PEOPLE WHO HAD PREVIOUSLY HAD DENGUE AND THEN GOT THE VACCINE HAD AN EXAGGERATED REACTION THE NEXT TIME THEY WERE EXPOSED. SO I DON’T THINK WE COMPLETELY HAVE ALL THE DATA FROM THAT AND I DON’T WANT TO SAY ANY MORE ABOUT IT BECAUSE I THINK MORE OF THE STORY TO BE TOLD BUT IT JUST SHOWS THE IMPORTANCE OF HAVING CAREFUL CLINICAL STUDIES AND ERRING ON THE SIDE OF CAUTION WHEN A NEW AND POTENTIALLY SERIOUS SIDE EFFECTS EMERGES. EVERY VACCINE HAS TO BE CAREFULLY STUDIED AND I THINK WE DESPERATELY NEED A DENGUE VACCINE THAT WORKS FOR EVERYONE. I THINK THIS FIRST ONE DOES HAVE SOME PROBLEMS AND IT REMAINS TO BE SEEN WHETHER OR NOT IT WILL PROVE TO HAVE A PUBLIC HEALTH BENEFIT ANYWHERE ELSE IN THE WORLD.>>SO WE’RE REALLY ADJUSTING THE SAFE OF VACCINES AND SOME ARE MORE SAFE THAN OTHERS, AND THOSE IN THE U.S. ARE VERY SAFE. LET’S TALK ABOUT OTHER VACCINES THAT ARE USED IN CLINICAL PRACTICE. I KNOW THAT SOUTH DAKOTA IS, LIKE, TOP OF THE LIST FOR THE MOST VACCINATED STATE IN THE COUNTRY. BUT WHAT ABOUT HPV IN SOUTH DAKOTA, AND WHAT IS HPV?>>SO HPV STANDS FOR HUMAN PAPILLOMA VIRUS.>>A WART VIRUS.>>IT’S NOT A WART VIRUS, IT’S ACTUALLY A FAMILY OF VIRUSES, SOME OF WHICH CAUSE WARTS BUT MANY OF WHICH CAUSE MANY MORE SERIOUS DISEASES, LIKE CANCERS OF THE INTER-GENITAL TRACT IN BOTH MEN AND WOMEN AND OF THE HEAD AND NECK IN BOTH MEN AND WOMEN. THE CANCERS TEND TO HAPPEN LATER IN LIFE BUT OFTEN THESE INFECTIONS ARE ACQUIRED BY YOUNG PEOPLE, YOUNG ADULTS, AND THEY DEVELOP THE… [Overlapping Conversation]>>IT’S REALLY OUR SECOND CANCER VACCINE. THE FIRST ONE WAS THE HEPATITIS B VACCINE AND THIS ONE IS DESIGNED TO PREVENT THOSE TYPES OF CANCERS SO IT DOESN’T PREVENT THE COMMON SKIN WARTS, IT PREVENTS GENITAL WARTS WHICH ARE A NUISANCE, REALLY, BUT THEY’RE NOT A PLEASANT THING TO HAVE BUT ITS MAIN ROLE IS TO PREVENT CANCERS.>>AND CERVICAL CANCER, HEAD AND NECK CANCER MOSTLY –>>CERVICAL CANCER BUT ALSO CANCERS OF THE VULVA AND VAGINA IN WOMEN AND ANAL CANCERS IN BOTH MEN AND WOMEN. AND THE VACCINE IS VERY EFFECTIVE. I DID CLINICAL TRIALS, I DID MANY OF THE CLINICAL TRIALS THAT ENDED UP WITH THE LICENSURE OF THE VACCINE AND THE OTHER THING I WANTED TO POINT OUT THAT Dr. GEBERDING, AS YOU SAID, VACCINES GO THROUGH A LOT OF SAFETY TESTING, INCLUDING POST LICENSURE TESTING AND I THINK PEOPLE DON’T UNDERSTAND THAT THEY CONTINUE TO BE TESTED EVEN AFTER THEY’RE LICENSED. AND SO WITH HPV, UNFORTUNATELY, THERE WAS A LOT OF MYTHOLOGY BECAUSE IT IS A SEXUALLY TRANSMITTED INFECTION WHEN IT COMES TO THE GENITAL WARTS AND –>>I DON’T KNOW ABOUT YOUR CHILDREN BUT MY CHILDREN ARE NOT GOING TO HAVE SEX. THAT’S A JOKE.>>YES. A LOT OF PEOPLE WORRY ABOUT THAT AND IT REALLY IS — DOES NOT HAVE ANYTHING TO DO WITH THAT. ANY KIND OF SEXUAL CONTACT, WHETHER IT’S WILLING OR UNWILLING THAT YOUNG PEOPLE MAY HAVE, EXPOSES THEM TO THESE VIRUSES AND THE RISK OF THESE CANCERS AND THESE SEVERE INFECTIONS, SO PROTECTING THEM EARLY REALLY IS BENEFICIAL FOR ALL YOUNG PEOPLE.>>SO IT’S FOR YOUNG WOMEN AND MEN –>>THAT IS CORRECT.>>AND WHAT AGE DO WE ENCOURAGE THIS VERY IMPORTANT CANCER-PREVENTIVE VACCINE, WHEN?>>IT CAN BE GIVEN AS EARLY AS NINE YEARS OF AGE, TYPICALLY WE USE IT AS PART OF THE ADOLESCENT OR PRE-ADOLESCENT PLATFORM SO IT’S GIVEN AT 11 TO 12 YEARS OF AGE. IT CAN BE GIVEN TO YOUNG PEOPLE UP TO 26 YEARS OF AGE.>>YOU KNOW, THAT’S — IF WE COULD ENCOURAGE ONE PERSON TO GET THIS VACCINE FROM THIS SHOW, I WOULD BE SO PLEASED. THINK ABOUT IT, ENCOURAGE YOUR CHILDREN OR YOUR GRANDCHILDREN TO GET THE HPV VACCINE.>>ABSOLUTELY.>>PREVENT CANCER.>>UH-HUH.>>THE WHOLE STORY OF EPIDEMICS AND VACCINES ARE VERY INTERESTING TO ME AND I’VE THOUGHT ABOUT THE ISSUE OF THE STORY OF A 1918 TERRIBLE EPIDEMIC OF THE –>>PANDEMIC.>>PANDEMIC, YEAH. AND THE RESULT WAS THAT ALL THESE PEOPLE WERE KILLED THROUGHOUT THE UNITED STATES –>>ESTIMATED TO BE 100 MILLION DEAD ACROSS THE WORLD.>>YEAH. WE HAVE ONE MINUTE LEFT. VERY QUICKLY, FEW MINUTES WITH YOU AND WITH YOU, TOO, WHAT CAN WE SAY ABOUT THE IDEA OF PREVENTING AN EPIDEMIC WHEN THE TIME COMES? ARE WE GOING TO HAVE ENOUGH TIME TO DEVELOP A VACCINE WHEN A NEW BIRD FLU COMES?>>I THINK WE HAVE SOME EXPERIENCE WITH DEVELOP VACCINES QUICKLY AGAINST NEW STRAINS OF INFLUENZA THAT DEVELOP. THE 2009 PANDEMIC IS THE MOST RECENT ONE THAT WE HAVE AND THAT VACCINE WAS ACTUALLY DEVELOPED AND DEPLOYED VERY, VERY QUICKLY AS SOW AS NEWER VACCINE TECHNOLOGIES COME ALONG, I THINK WE CAN DO IT.>>15 SECONDS, JULIE, ANYTHING TO SAY.>>I’M NOT AS OPTIMISTIC. I THINK WE’RE FASTER THAN WE USED TO BE BUT NOT FAST ENOUGH TO PREVENT THE POTENTIAL FOR A LOT OF TRANSMISSION AND A LOT OF MORBIDITY AND MORTALITY, SO WE HAVE TO STILL DO MORE.>>WELL, AWESOME INFORMATION. AND NOW FOR THE ANSWER TO TONIGHT’S PRAIRIE DOC QUIZ QUESTION. THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES OR THE ACIP’S FUNCTION IS TO… A, MAKE ALL VACCINES. B, RECOMMEND THE TYPE OF VACCINE AND THE AGE IT SHOULD BE GIVEN. C, INCLUDE ACTORS, LIKE JENNY MCCARTHY, ON ITS PANEL. THAT’S KIND OF A TONGUE IN CHEEK JOKE. D, ADVISE STATE HEALTH DEPARTMENTS ABOUT METHODS TO CLARIFY THE EFFECTIVENESS OF VACCINES. THE CORRECT ANSWER IS “B,” RECOMMENDS THE TYPE OF VACCINE AND AT WHAT AGE IT SHOULD BE ADMINISTERED. WE’LL BE BACK AFTER THIS…>>WELCOME TO YOUR PRAIRIE DOC LIBRARY AT WWW.PRAIRIEDOC.ORG. WHEREVER YOU LIVE OR TRAVEL, YOU AND YOUR FAMILY CAN ENJOY FREE AND EASY ACCESS 24 HOURS A DAY. SEARCH FOR A SPECIFIC TOPIC. BROWSE THROUGH THE TELEVISION SHOWS, RADIO PROGRAMS AND BLOG PAGE. YOU, YOUR FAMILY AND FRIENDS AROUND THE WORLD CAN LEARN FROM PHYSICIANS AND OTHER HEALTH PROFESSIONALS ANSWERING QUESTIONS ON A VARIETY OF MEDICAL TOPICS. VISIT YOUR PRAIRIE DOC LIBRARY TODAY AT WWW.PRAIRIEDOC.ORG.>>VACCINES PROTECT PEOPLE FROM SCOURGES OF ILLNESS WITH MINIMAL RISK. SMALLPOX HAS BEEN AROUND FOR MANY MILLENNIUM. FOR THOUSANDS OF YEARS, IT WAS A DEADLY ILLNESS THAT KILLED MORE THAN 35% OF ADULTS AND 80% OF CHILDREN WHO CONTRACTED THE DISEASE. THAT IS, UNTIL THE SMALLPOX VACCINE WAS DISCOVERED IN 1796. NOTING THAT MILKMAIDS RARELY GOT SMALLPOX, BRITISH RURAL PHYSICIAN, EDWARD JENNER, FOUND THAT VACCINATION FROM THE MILDER DISEASE, COWPOX, PROVIDED SUBSTANTIAL IMMUNITY FROM SMALLPOX WITH GREAT OVERALL BENEFIT, DESPITE A SMALL RISK TO THE RECIPIENT. AFTER A VACCINATION CAMPAIGN LEAD BY THE WORLD HEALTH ORGANIZATION, WORLDWIDE DEATHS WERE REDUCED FROM TWO MILLION PER YEAR IN 1967 TO ZERO IN 1977. HUMAN SMALLPOX INFECTIONS WERE VIRTUALLY ELIMINATED FROM THIS WORLD BECAUSE OF VACCINATIONS. ANOTHER EXAMPLE OF CLEVER MANIPULATION OF THE IMMUNE SYSTEM COMES FROM A STORY ABOUT PNEUMONIA VACCINE. IN A 2003 STUDY, RESEARCHERS NOTED THERE HAD BEEN A HUGE DROP IN HOSPITALIZATIONS OF THE ELDERLY FOR PNEUMONIA, WITH 12,000 FEWER YEARLY DEATHS ESPECIALLY IN THOSE OLDER THAN 85. THIS HAPPENED SINCE THE ADVENT OF ROUTINE CHILDHOOD PNEUMONIA VACCINATION. ALTHOUGH WE NOW ENCOURAGE TWO DIFFERENT PNEUMONIA VACCINES FOR THOSE OLDER THAN 65, THE AUTHORS OF THE STUDY CLAIM THAT IT WAS THE ROUTINE VACCINATION IN CHILDREN THAT WAS RESPONSIBLE FOR THE REDUCTION OF PNEUMONIA IN THE ELDERLY. THUS, HERD IMMUNITY PROFOUNDLY PROTECTS IMMUNE-DEFICIENT ADULTS BY REDUCING THEIR EXPOSURE TO SICK KIDS. THERE HAS BEEN A DANGEROUS UNTRUE RUMOR THAT VACCINATIONS IN CHILDREN ARE RESPONSIBLE FOR AUTISM. DESPITE THE HUMAN NATURE WISH TO FIND SOMEONE TO BLAME FOR THIS CONDITION, AUTISM APPEARS IN SIMILAR RATES IN CHILDREN WHO ARE GIVEN AND NOT GIVEN VACCINATIONS. DON’T GET ME WRONG, VACCINES CARRY SOME RISK, BUT IT ALL DEPENDS ON THE SPECIFIC INFECTION AND THE TYPE OF VACCINE. TAKE, FOR EXAMPLE, THE VACCINE FOR DENGUE FEVER WHERE THE RISK OF SIDE EFFECTS ARE SIGNIFICANT. WITH DENGUE VACCINE, TEN ARE SAVED FOR EVERY ONE CHILD WHO IS HARMED. COMPARE THAT WITH THE MEASLES, MUMPS, RUBELLA VACCINE SERIES GIVEN IN THE U.S. WHICH HAS MILD SIDE EFFECTS INCLUDING FUSSINESS, MILD FEVER, INJECTION-SITE SORENESS, AFFECTING ONE CHILD IN FOUR. THERE IS MILD JOINT PAIN, RASH, MILD GLANDULAR SWELLING, AND LOSS OF APPETITE AFFECTING ONE IN 50, AND HIGH FEVER AND PLATELET PROBLEMS AFFECTING ONE IN 25,000. MUCH BETTER THAN DENGUE VACCINE. THE BENEFITS OF THE MMR VACCINE FAR OUTWEIGH THE RISKS. VACCINATION, A CLEVER MANIPULATION OF OUR IMMUNE SYSTEM, PROTECTS AND WILL PROTECT US FROM THE SCOURGES OF THE FUTURE. MUSIC WELL, A BIG THANK YOU TO OUR GUESTS, DR. ARCHANA CHATTERJEE, AND, VIA SKYPE, DR. JULIE GERBERDING. THANK YOU, JULIE. THEIR EXPERIENCE AND KNOWLEDGE MADE TONIGHT’S SHOW A SUCCESS. OVER THE YEARS, “ON CALL WITH THE PRAIRIE DOC” HAS CREATED A SIGNIFICANT LIBRARY OF GOOD, SCIENCE-BASED MEDICAL INFORMATION. FROM OUR TV BROADCASTS, WEB STREAMING, RADIO PROGRAMS AND BLOGS, WE HAVE SAVED SOME WONDERFUL ADVICE AND EXPLANATIONS OF MEDICAL CONCERNS. WE ARE WORKING TO MAKE THAT LIBRARY ACCESSIBLE TO EVERYONE. PLEASE GO TO OUR WEBSITE, WWW.PRAIRIEDOC.ORG, AND EXPLORE THE PAGES THAT WE’VE CREATED FOR YOU AND YOUR HEALTH. THAT DOES IT FOR TONIGHT. FROM ALL OF US HERE AT “ON CALL WITH THE PRAIRIE DOC,” UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE. MUSIC>>”ON CALL” WITH THE PRAIRIE DOC IS VERY IMPORTANT TO A LOT OF PEOPLE IN THIS AREA AND THIS REGION BECAUSE IT COMMUNICATES A LOT OF VERY VALUABLE INFORMATION ON HEALTH CARE, MEDICAL ISSUES, ANSWERS SPECIFIC QUESTIONS. THIS PROJECT TAKES DOLLARS. WE HAVE PEOPLE IN STUDIOS AND WE HAVE PEOPLE THAT HAVE TO BE PAID AND WE HAVE TO DO PRODUCTION COSTS, EVEN THOUGH Dr. HOLM’S TIME, OUR TIME, THE GUEST TIME IS ALL DONATED. WE HAVE A GREAT FOUNDATION CALLED THE HEALING WORDS FOUNDATION THAT OVERSEES THIS WHOLE OPERATION AND IS RESPONSIBLE FOR SOME OF THE FUNDRAISING TO PROMOTE THESE PROGRAMS, SO THE WEBSITE IS PRAIRIEDOC.ORG, O-R-G. PRAIRIEDOC.ORG, GO THERE AND DONATE IF YOU’RE SO INCLINED AND WE THANK YOU VERY MUCH. MUSIC>>MAJOR FUNDING FOR “ON CALL WITH THE PRAIRIE DOC” HAS BEEN PROVIDED BY: >>AVERA IS A PROUD SPONSOR OF “ON CALL” ON SOUTH DAKOTA PUBLIC BROADCASTING. LARSON MANUFACTURING IS PROUD TO SUPPORT “ON CALL TELEVISION” AS IT CONTINUES TO OPEN DOORS FOR IMPORTANT MEDICAL INFORMATION. AND BY THE SOUTH DAKOTA FOUNDATION FOR MEDICAL CARE, THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION FOR SOUTH DAKOTA. AND WITH THE ONGOING SUPPORT OF THESE INDIVIDUALS AND INSTITUTIONS…

Leave a Reply

Your email address will not be published. Required fields are marked *