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Shots heard around the world

By Michael Ross, Founding Partner, ROAMcare


In July 2020, the World Health Organization and UNICEF issued a joint statement warning of an “alarming decline” of children receiving vaccines due to disruptions in immunization services caused by the COVID-19 pandemic, citing a “substantial drop in the number of children completing three doses of the vaccine against diphtheria, tetanus and pertussis (DTP3)” in the early part of the pandemic. DPT3 is used as an indicator of childhood vaccination worldwide. At the time, UNICEF Executive Director Henrietta Fore, urged a swift resumption of childhood immunization programs to not threaten children’s lives trading one health crisis for another. (1)


One hundred, thirty-seven years ago, Louis Pasteur formulated the first rabies vaccine from rabbits and administered it to dogs to attempt to prevent the disease in domestic animals. A year later, in 1885, Pasteur injected a form of the rabies vaccine into nine year old Joseph Meister who had been mauled by a rabid dog. The boy survived, the first to do so after traumatic exposure to rabies, and thus began a long march to developing vaccines against many threats to children’s, and adults’, lives.


The rabies vaccine was not the first vaccine developed for an animal. That would have been the chicken cholera vaccine in 1879, also developed by Pasteur. But when he gave that first rabies vaccine five years later, he was setting a course for protections from a then universally deadly disease in humans by inoculating the animal. Prevent the disease in the animal and the animal cannot transmit the disease to the human. And thus, today dogs are roaming the streets with rabies tags hanging from their collars indicated they bear no risk to their human companions other than perhaps smothering them in dog hugs.


Animal vaccines were new in the 1880s, but then was not the first time animals had been used in the development of vaccines. That first happened 90 years earlier when Edward Jenner injected cowpox into humans to prevent the closely related smallpox virus. From the cowpox experiments in 1796 through the animal studies in the 1880s and to early research with toxins and antitoxins in the 1920s, the field was set for attempts to prevent diseases, many then nearly universally fatal. By the 1930s, diphtheria, tetanus, anthrax, cholera, plague, typhoid, and tuberculosis vaccines were developed, and by mid-century work was completed on vaccines for measles, mumps, and rubella. The latter half of the century brought vaccinations against chicken pox, pneumonia, and hepatitis B. This century saw the successful development of rotovirus, herpes zoster, and human papilloma virus (HPV) vaccines. Within the last year, the vaccine against SARS-CoV2 was developed to protect against the novel CoViD-19 virus.


We have been concentrating on COVID for the last 18 months and may have forgotten, or at least not actively considered, all the other vaccines and routine vaccination recommendations for children and adults. This was illustrated last month when this year’s influenza vaccine strains were selected with no notice by the mainstream media and little fanfare even in specialty media circles.


The 2020-2021 flu season was minimal, almost non-existent, while experts project this year’s flu season may be significantly virulent. They cited two possible reasons for this. We know the body’s immune system thrives on small, short term exposures and that after the absence of a pathogen, if one does become infected, the symptoms typically are intensified. The lack of exposure to the flu virus deprived the body of an additional weapon to augment the flu vaccine. Second, there may be a social component to a more substantial flu season as people, after longer than a year of “isolation,” will now without mandated masking and social distancing, forsake the mitigation practices that contributed to the uneventful 2020-2021 flu season. These concerns apply to all viruses. In addition to minimal flu activity, last year saw record low incidents of respiratory syncytial virus (RVS) and rotovirus in children, adenovirus and rhinovirus in everybody, and subsequently less non-COVID induced pneumonias.


There are many more vaccines than COVID, and many more pathogens responsible for illnesses other than respiratory diseases, and now is the time to refresh yourself and remind your patients about them. Patients are more aware of vaccines and the benefits of immunization protocols but may not be up to date or complete with their recommended vaccine schedules. Pharmacists have an opportunity to address vaccinations with our patients, in the pharmacies as they present themselves for prescriptions and in the hospitals as part of our discharge counselling. Question them about tetanus boosters, initiation or resumption of shingles or pneumonia series, assessments regarding hepatitis or meningococcal vaccines, appropriateness of human papilloma virus or haemophilus influenzae b virus vaccines, and their traveling immunization needs, while reminding of this year’s flu vaccine.

For years we have relied on them to keep us safer and healthier than we were just a single generation ago, but vaccines only work if people are willing to be vaccinated. Be willing and encourage others to be also. Joseph Meister did, and he lived to talk about it.


 

Links to US Centers for Disease Control and Prevention immunization schedules for 2021:

For adults age 19 and older Table 1: By age Table 2: By indication

For children and adolescents, birth to age 18 Table 1: By age Table 2: Catch up schedule Table 3: By indication

Resources

Information for health care providers Information for adults Information for parents

 

(1) World Health Organization. (2020, July 17). WHO-and-UNICEF-warn-of-a-decline-in-vaccinations-during-covid-19 [Press release]. https://www.who.int/news/item/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19

 



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