Click here to view next page of this article

 

New Vaccines for Children -- Risks and Dangers

Pneumococcus vaccine. There are about 3,000 cases of meningitis a year due to pneumococcus. Last week in a young child developed pneumococcal meningitis and was devastated. The child was brought in within 12 hours of onset of disease and is terribly brain-damaged now a week later. About 50,000 cases of bacteremia occur annually. Most of those in children. Pneumonia occurs in both adults and kids but it is estimated that there are up to 7 million cases of acute otitis media a year in the United States, with the pneumococcus. And the problem with the pneumococcus is of course is this right here. That child that I was telling you about, had a penicillin-resistant pneumococcal meningitis. These organisms are becoming not only penicillin-resistant but, multiple drug resistant just like we saw with TB a few years ago. And clearly, throwing more antibiotics against this bacterium is not the answer, in fact thatís the problem.

This is a polysaccharide vaccine. That is, itís the sugar coating on the outside of the organism. And that 23 valent vaccine there goes by either Pnu-Immune or Pneumovax, depending on which company you buy it from - contains 23 different serotypes of the pneumococcus and included in those 23 serotypes in fact are those serotypes in green that are most commonly penicillin-resistant.

Now when you take polysaccharides however, and like them to proteins you change the entire nature of the antigen, and weíll come back to that in just a second. The other problem with the current 23 valent pneumococcal vaccine is that there are multiple serotypes amongst respiratory and systemic isolates. This is not going to be like H flu B.

Now there are four manufacturers who at least were working to develop a protein conjugate pneumococcal vaccine. Basically what they did is they took the same protein from their respective Hemophilus B vaccines.

Now Iím not going to show you a bunch of numbers and data, but I just want you to look over here. When you look at these 7-valent protein conjugated pneumococcal vaccines in infants at two, four and six months of age, the immune response is pretty good. However, you will notice that not all the serotypes - for example 23 F - gave the same level of response.

So what do we have? Well, we have an improved vaccine because it works in these young infants. Is this going to prevent invasive disease such as the child who was devastated last week? I think so. I think it probably will.

Now there are lots of questions about these vaccines and I will tell you, they are probably at least two to three years away. One of them is: is the response going to be equal to all the different serotypes? Whatís the right formula for this? Will there be qualitative differences in the antibody?

Pertussis. This child has been coughing so much that he actually has subconjunctival hemorrhages. I donít know about you but I distinctly remember at that time my eight-year-old sister, when I was a child, leaning over the fence in the backyard coughing, coughing, coughing and then that big whoop. Pertussis in now a disease of young babies and adults. Nevertheless, pertussis.

Whatís going on with pertussis? Starting in about the 1970ís - I think you are all aware - that the number of cases of pertussis in the United States has continued to slowly but steadily increase. These are data up through 2006, which are the most recent, showing that this trend has continued. Youíll notice also, even in the vaccine era you see a peak about every two to three years, and we certainly saw that in 2006.

Now the other problem, of course, is the vaccine. This vaccine was introduced, whole cell pertussis vaccine, in 1943. The way itís made, but the way, is that you basically take the Bordetella pertussis organism, which is a gram-negative bacterium, which of course means that it includes what? Endotoxin. And you grind it up in a test tube and you inject it into children. Itís a fairly dirty vaccine, with limited potency standards.

Well, if you want a new and improved vaccine, what do you do? You call the Japanese and ask them to make it for you, right? Because they are the ones that do all this stuff, and thatís exactly what happened. The Japanese essentially dissected out the organism and identified those four antigens in those 3,000 that led to immunity and got rid of the 2,996 others. The four are listed here. One of them you need to remember and that is pertussis toxin. This is the thing that causes most of the symptoms of pertussis. The high lymphocyte count, the persistent coughing.

Now, thatís simple so far. The problem for you is going to be that there are 13 different acellular vaccines out there being developed by various pharmaceutical companies. So if you liked all the cephalosporins that youíll hear about in the next couple of hours, you will love this. Because there are probably going to be 10 or 11 of them.

Varicella zoster. Hereís an uncomplicated lesion right here. Hereís one thatís secondarily infected with staph aureus. That can lead to some scars which can be problematic, but certainly isnít going to kill the child. This on the other hand is nasty stuff. This is what all of you now recognize as necrotizing fasciitis or group A streptococcal invasive S. Pyogenes disease. This little girl came down from the Winnebago Indian Reservation.

Varicella during pregnancy - about 1:2000 pregnancies are complicated by varicella - they have the risk of transmitting the disease to their offspring and they wind up with horrible deformities, or this time of year - just last Friday afternoon, we had a phone call from the delivery room.