The Vaccine Non-troversy

Vaccines are the greatest public health accomplishment in the history of humankind.

Vaccines FTW

For various reasons, some parents refuse to vaccinate their children. Their excuses include:

  • It’s against their religion
  • My child receives too many vaccines at one time
  • My child doesn’t need vaccines–he/she is perfectly healthy
  • Vaccines are not natural
  • Vaccines are harmful

The main type of parent that I see is the generally apprehensive one. This parent hasn’t fully committed to getting their child vaccines, but isn’t sure who to believe and hates seeing their child in pain. Look, I completely understand that. But would you rather your child cry for a few minutes be immunized, or would you rather your child be subjected to this:

This child has a pertussis infection. This child is gasping for air. This child is fighting to breathe. This child, and other children with pertussis infections, can die.

These children are infected with measles. As you can see, this particular outbreak did not happen in the United States. Here in the U.S., the vast majority of us have the luxury of finding relatively cheap immunizations for our children. We have this luxury, while those in less developed countries do not. And what excuses do we have for not immunizing our children? I refer you to the list above.

I don’t want this blog post to strictly about showing you videos of children and families in pain, but I wanted to show you some examples of infections that many of us haven’t seen before. The fact that many of these diseases are not common in the US anymore has created a sense of calm. The only problem with this is that we forget. We forget what these diseases can do. We become complacent and believe that the side effects of the vaccines are much worse than the actual disease. Take a look at those videos again and tell me that your little fever of 99.9 is worse than gasping for breath. Tell that to the parents of a newborn in King County, Washington, who died of whooping cough last December.

One death is one too many for diseases that are preventable. But let’s back up a little bit and talk about the history of vaccines.

F**king Vaccines, How Do They Work?*

*The title to this section is a shout-out to my Insane Clown Posse-loving friends, the Juggalos. P.S. if you are a Juggalo, you are not my friend.

Basically, vaccines work by mimicking a disease and tricking your immune system into fighting that disease. A lot of vaccines use dead viruses of said disease in order to accomplish this; however, some use viruses that are alive.  Let’s look at influenza, aka the flu, for example.

According to the CDC, there are several types of flu vaccines you can receive. The regular flu shot uses inactivated vaccine that contains dead flu viruses. In recent years, a nasal spray/mist has been developed as well. It contains live, attenuated (weakened)  flu viruses. This basically means that the flu viruses are alive, but are weakened to a state in which they cannot cause the flu.  High-dose flu shots for people 65 or older have been developed in the past few years as well. This past year, many flu clinics began offering an intradermal flu shot, which is injected into the skin as opposed to the muscle like the regular flu shot. It uses a much smaller needle and requires less antigen (the part of the vaccine that helps your body build up protection against flu viruses) to be as effective as the regular flu shot.

Vaccines Have Worked Alright…Maybe TOO Well

As you can see from the first graphic on this blog post, vaccines have been one of the single most effective public health tools against preventable diseases in the world. Unfortunately, a lot of people have forgotten exactly how bad some of these preventable diseases are. Some people, based on anecdotal evidence and word-of-mouth, think that vaccines cause more harm than good. These people, whose numbers are few but voices are loud, have been around as long as vaccines have been around. But now, they have a tool that increases the reach of their wrong-ness. Which leads me to…

The Rise of the Internet

I have a love/hate relationship with the internet. I wouldn’t have a job without it. The internet brings me almost everything I need from an informational standpoint. In fact, I don’t watch much news at all anymore. I follow  reporters, news stations, and newspaper/magazines on Twitter. It’s the first thing I read in the morning and one of the last things I read at night.  Anyone can have a voice on the internet, and as long as we keep it that way, it is a wonderful tool for freedom of expression.

But therein lies the problem as well: anyone can have a voice. And as we know from living in the world and interacting with humans, a lot of us are wrong. A lot of us do not understand science or use the scientific method, but we still are able to voice our beliefs on sciencey things. Which brings me to…

McCarthyism

I honestly believe that Jenny McCarthy believes she’s doing what is best for her son, that she loves her son, and believes that what she says is correct. However, she is wrong. People who believe that vaccinations do no good, people who believe that vaccinations cause more harm than good, and people who refuse to see the mountain of scientific evidence refuting their claims — they are wrong.

jenny-mccarthy-autismAnd being wrong has consequences.

A lot of people look up to Jenny McCarthy. She has a platform of celebrity that many of us do not have. Not many people get to pen articles for the Huffington Post (in related news–WTF, Huffington Post?) But she didn’t come up with her beliefs on her own.

In 1998, Andrew Wakefield announced at a press conference at the Royal Free Hospital in London his concerns regarding the safety of the MMR vaccine (measles, mumps, and rubella) and its relationship to autism. He never proved that this vaccine caused autism, but his “concerns” were enough to start a movement, including Jenny McCarthy’s Generation Rescue.

A 2003 review in The Archives of Pediatrics and Adolescent Medicine came to the conclusion that there was no evidence of Wakefield’s claim. Subsequently, Wakefield has been made a laughing stock of the scientific community, numerous ethical violations have come to light, and the British Medical Journal even said his work was fraudulent.

You would think this would be enough for McCarthy to come to her senses, do the responsible thing, disown Wakefield and the anti-science movement, and move on. Alas, that is not what happened.  And therein lies the shame of this whole debacle: Even when presented with the truth, she refuses to acknowledge it. Think of how many people she could help were this the case.

What’s with the Weird, Scary Cloverleaf Bacteria?

Huh, I guess we took a little break there for a while. Sorry about that. We don’t even have a good excuse for why we haven’t been updating. It’s not like we had a death in the family, or a medical crises. We didn’t even go on vacation. Well, here’s a cute picture of a dog in a sleeping bag:

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All better now?

Anyway, on to what I really wanted to talk about today: Antibiotic resistant superbugs!

The CDC recently sent out a press release calling for immediate action to halt the spread of antibiotic-resistant bacteria that they’re calling CRE. The acronym stands for Carbapenem-Resistant Enterobacteriaceae, or in plain English, bacterial strains that normally live in our intestines but can wreak havoc when they get into the blood, bladder, or in wounds, and have acquired the ability to withstand our most-effective antibiotics. Apparently these antibiotic-resistant strains have been on the rise for about 10 years now, but they are finally becoming widespread and are incredibly lethal, killing about half of those who are infected. These strains do not pose a great threat to an average, healthy person who spends little time in the hospital, but can be very dangerous to your elderly grandmother, or anyone staying in a hospital or long-term care facility.

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But now I will get to what I really really want to talk about today: The image that accompanies the CDC press release. It’s a backlit agar plate, held by blue-gloved disembodied hands. The bacteria growing on the plate makes four unusual clover leaf shapes. Somehow the picture comes across as threatening, even though few people know what those clover leafs actually mean. I have an advanced degree in microbiology and I still had to look it up.

Turns out that cloverleaf plate is the end result of a Modified Hodge Test, which is really just an adaptation of the cloverleaf test developed by Kjellander and Myrbäch back in 1964. The test tells you whether or not a certain bacterial strain is secreting an enzyme that can break down a specific antibiotic, which tells you if it is resistant to that antibiotic. If your strain makes a nice, well-defined clover leaf shape, then it is resistant to the antibiotic. If the plate looks more like a dark circle with a cross through it, then the strain is susceptible to the drug.

How does it work? Well, first you cover the plate with a solution of garden-variety E. coli. Why E. coli? This bacteria is susceptible to the antibiotic and makes a yellowish lawn all over the plate, except for a circle around the little white disk, which is impregnated with the antibiotic. The antibiotic from the disc seeps into the surrounding agar and prevents any E. coli from growing there. Next, you streak a line of a bacteria that is resistant to the antibiotic coming out from the white disc, as well as a strain that is susceptible. These are the positive and negative controls, respectively. Then, you streak a line of your unknown bacteria. I think the CDC did this part twice so that the plates would look like luck four-leaf clovers, instead of the three-leaf ones, but it does look nifty, so I suppose you can’t blame them. Then, you culture the plates at around 98 degrees and see what grows.

First of all, the E. coli will grow everywhere, except for where there are antibiotics leeching into the agar. The other bacterial strains that produce the antibiotic-eating enzymes will be surrounded by E. coli growth, since the enzymes make the agar safe for the E. coli This creates the round leaf shape. Strains that are susceptible to the antibiotic and do not make these enzymes will grow poorly next to the disk, and will not be surrounded by E. coli, so the dark (bacteria-free) part will look more like a piece of pie.

And that’s why that picture of the cloverleaf plate is so scary, but it shows several strains of bacteria that are circulating in our hospitals that don’t give a *bleep* about our antibiotics. Even scarier, is that these bacteria have the potential to spread the genes for these antibiotic-eating enzymes to other bacteria, which could results in all sorts of new, deadly “superbugs.”

What can YOU do about CRE? Unfortunately, not much. The responsibility is going to fall on the hospitals to institute stricter cleaning regimes and isolation of CRE-positive patients to prevent its spread. Also, public health labs will need to do more antibiotic resistance testing (AKA Clover leaf plates!) to find the CRE-resistant strains, track their movement, and to make sure that they are not treated with useless antibiotics.

BUT! You can act wisely toward the bacterial strains that are still susceptible to antibiotics.

-ALWAYS finish ALL of your prescribed antibiotics.

-NEVER take antibiotics for a viral infection – and don’t pester your doctor about it, because sometimes they give out antibiotics just because they’re tired of being hounded when whiny kids have ear aches.

-Buy organic meats and dairy products that do not come from animals that have been treated with unnecessary, constant antibiotics.

-Do not buy antibacterial soaps or other antibacterial products. The antibiotic in these products does not make you any safer, and tends to accumulate in the environment, where bacteria form a resistance to it.   If you much, alcohol-based hand sanitizer is ok.

The superbugs may still win in the end, but at least we can stave off their dominion for as long as possible…