Do we need a new approach to making vaccine recommendations?

Crowcroft, Natasha S.; Deeks, Shelley L.; Upshur, Ross

doi:10.1136/bmj.h308

Cited by 13 publications

(15 citation statements)

References 23 publications

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“…The safe levels and longterm effects of vaccine ingredients such as adjuvants and preservatives are also unknown [13]. Other concerns include the safety and costeffectiveness of newer vaccines against diseases that are potentially lethal for individuals but have a lesser impact on population health, such as the group B meningococcus vaccine [14].…”

Section: Introductionmentioning

confidence: 99%

Pilot comparative study on the health of vaccinated and unvaccinated 6- to 12- year old U.S. children

Mawson¹,

Ray²,

Bhuiyan³

et al. 2017

J Transl Sci

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Vaccinations have prevented millions of infectious illnesses, hospitalizations and deaths among U.S. children, yet the long-term health outcomes of the vaccination schedule remain uncertain. Studies have been recommended by the U.S. Institute of Medicine to address this question. This study aimed 1) to compare vaccinated and unvaccinated children on a broad range of health outcomes, and 2) to determine whether an association found between vaccination and neurodevelopmental disorders (NDD), if any, remained significant after adjustment for other measured factors. A cross-sectional study of mothers of children educated at home was carried out in collaboration with homeschool organizations in four U.S. states: Florida, Louisiana, Mississippi and Oregon. Mothers were asked to complete an anonymous online questionnaire on their 6-to 12-year-old biological children with respect to pregnancy-related factors, birth history, vaccinations, physician-diagnosed illnesses, medications used, and health services. NDD, a derived diagnostic measure, was defined as having one or more of the following three closely-related diagnoses: a learning disability, Attention Deficient Hyperactivity Disorder, and Autism Spectrum Disorder. A convenience sample of 666 children was obtained, of which 261 (39%) were unvaccinated. The vaccinated were less likely than the unvaccinated to have been diagnosed with chickenpox and pertussis, but more likely to have been diagnosed with pneumonia, otitis media, allergies and NDD. After adjustment, vaccination, male gender, and preterm birth remained significantly associated with NDD. However, in a final adjusted model with interaction, vaccination but not preterm birth remained associated with NDD, while the interaction of preterm birth and vaccination was associated with a 6.6-fold increased odds of NDD (95% CI: 2.8, 15.5). In conclusion, vaccinated homeschool children were found to have a higher rate of allergies and NDD than unvaccinated homeschool children. While vaccination remained significantly associated with NDD after controlling for other factors, preterm birth coupled with vaccination was associated with an apparent synergistic increase in the odds of NDD. Further research involving larger, independent samples and stronger research designs is needed to verify and understand these unexpected findings in order to optimize the impact of vaccines on children's health.

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Section: Introductionmentioning

confidence: 99%

Pilot comparative study on the health of vaccinated and unvaccinated 6- to 12- year old U.S. children

Mawson¹,

Ray²,

Bhuiyan³

et al. 2017

J Transl Sci

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“…Ft-ba kerül. Összehasonlításul a 2. ábrán feltün-tettük, hogy mennyibe kerül egy életév megmentése né-hány kiterjedten használt védőoltással [31].…”

Section: áR-érték Arányunclassified

“…Egy védőoltással megmentett életév költsége kanadai adatok alapján [31]. A függőleges tengely ezer kanadai dollárban érten-dő, 1 kanadai dollár = 210 forint.…”

Section: áBraunclassified

Bexsero, egy új, meningococcus elleni vakcina

Lakos¹,

Torzsa

Ferenci

2016

Orvosi Hetilap

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A meningococcusok közül Magyarországon többnyire a B szerocsoportú okozza a legtöbb megbetegedést. Az ellene kifejlesztett egyik oltás (Bexsero) 2014 nyarától Magyarországon is kapható. A szerzők összefoglalják a betegséggel és az oltással kapcsolatos legfontosabb ismereteket, illetve tárgyalják a vakcinával kapcsolatos jelenleg még nyitott kérdéseket irodalmi áttekintés alapján. Az immunológiai adatokon alapuló előzetes várakozások alapján a Bexsero védelmet adhat e ritka, de igen súlyos megbetegedés ellen. Az oltás azonban rendkívül költséges, klinikai hatékony-sága még tisztázatlan, és szokatlanul gyakran okoz lázreakciót, főleg csecsemőkorban, amikor a legnagyobb szükség lenne rá. A szerzők véleménye szerint a hazai ajánlás megfogalmazásával célszerű lenne megvárni, amíg a másutt szerzett tapasztalatok alapján jobban meg lehet ítélni az oltás hasznát, kockázatait, költséghatékonyságát. Lép-vagy komplementhiányos és egyéb immunszupprimált betegeknél, valamint kiemelkedően magas egyéni kockázat esetén a Bexsero alkalmazása már most is indokolt. Orv. Hetil., 2016, 157 (7), 242-246. Kulcsszavak: meningococcus B-vakcináció, Bexsero, hatásosság, biztonság, ár Bexsero, a novel vaccine against meningococcusMeningococcus B is the most prevalent Neisseria meningitidis serogroup isolated in Hungary. Bexsero is one of the vaccines developed against it, which has been available in Hungary since the summer of 2014. The authors summarize the most important issues and open questions concerning the disease and the vaccine based on literature review. Based on immunological evidence, it is expected that Bexsero provides protection against this rare but very serious infection. However, the vaccine is extremely expensive, the clinical effectiveness has not yet been proven and it frequently causes fever, especially in infants where the vaccine is most needed. According to the opinion of the authors, the formulation of a Hungarian guideline concerning the application of Bexsero should be postponed until the accumulating international experience makes it possible to better judge the vaccine's benefits, risks and cost-effectiveness. For patients with asplenia, complement defect or other immunological defect, or in case of markedly increased individual risk of contracting the disease, the vaccination is already justified. ÖSSZEFOGLALÓ KÖZLEMÉNYÚgy tűnik, elmúltak azok a boldog békeidők, amikor olcsó tömegoltásokkal védekeztünk a nagy populációkat érintő, súlyos következményekkel járó fertőzések ellen. A megbetegedéssel kapcsolatos veszélyek messze felül-múlták az oltási mellékhatások okozta esetleges károso-dások súlyosságát, gyakoriságát, és az oltások egyértel-műen költséghatékonyak is voltak. Ahogy azonban megritkultak a nagy halálozással, gyakori és maradandó károsodással járó, tömegeket érintő fertőzések, megnőtt az igény a kevésbé súlyos vagy kevésbé gyakori fertőzé-sek elleni oltások kifejlesztésére. A vakcinaipar is sokat fejlődött, új -korábban elképzelhetetlen perspektívákat nyitó, de persze egyúttal kevésbé kipróbált és g...

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“…Licensed in Canada since late 2013, 4CMenB vaccine is presently publicly funded only for those aged 2 months to 17 years who meet high-risk criteria. This includes individuals with complement, properdin, factor D or primary antibody deficiencies; human immunodeficiency virus infection; acquired complement deficiencies; functional or anatomical asplenia; or cochlear implants (Crowcroft et al , 2015; Ontario Ministry of Health and Long-Term Care, 2015). As happened in the past with other now-common and successful vaccines, the cost-effectiveness of routine 4CMenB vaccination in Ontario has been challenged (Tu et al , 2014).…”

Section: Introductionmentioning

confidence: 99%

Paediatric meningococcaemia in northwestern Ontario, Canada: a case for publicly funded meningococcal B vaccination

Eton

Tsang²,

Ulanova

2016

JMM Case Reports

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Introduction:Neisseria meningitidis serogroup B is an important infectious agent in developed countries, including Canada. Infants are particularly susceptible to infection with serogroup B because of immature immune systems, pathogen virulence factors and changing serogroup dynamics in the post-vaccination era. Currently, the Ontario provincial government does not include serogroup B in its routine publicly funded meningococcal vaccination program.Case Presentation:A formerly well 14-month-old male presented to a tertiary hospital emergency department with fever, minor respiratory problems, diffuse purpuric rash, distended abdomen, tachycardia, and history of one episode of vomiting and melena each. Meningococcaemia was immediately suspected, and he was treated with ceftriaxone, cefotaxime and vancomycin before transfer to a different acute care facility within 12 h. N. meningitidis serogroup B, sensitive to ceftriaxone and penicillin, was identified in his blood. The patient developed gangrene of the lower legs and underwent bilateral below-knee amputation 8 days post-admission.Conclusion:This instance of meningococcaemia with extensive sequelae is an example of the various serious outcomes of meningococcal infection. It provides persuasive reason for routine publicly funded vaccination against N. meningitidis serogroup B in Ontario.

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Do we need a new approach to making vaccine recommendations?

Cited by 13 publications

References 23 publications

Pilot comparative study on the health of vaccinated and unvaccinated 6- to 12- year old U.S. children

Pilot comparative study on the health of vaccinated and unvaccinated 6- to 12- year old U.S. children

Bexsero, egy új, meningococcus elleni vakcina

Paediatric meningococcaemia in northwestern Ontario, Canada: a case for publicly funded meningococcal B vaccination

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