Would You Test the Anthrax Vaccine on Your Child? In a disaster, there are tragedies in loss of life and quality of life caused by many unavoidable circumstances, but a large portion of disaster tragedies can be mitigated for in pre-disaster planning and action. A case in point is the modern use of vaccination. After the Haiti earthquake, cholera was introduced into their community. This is a disease that can be avoided by vaccination. In this article, I open the disaster vaccination topic with 1). the latest summary of the cholera epidemic in Haiti followed by 2). the latest news on potentially testing the anthrax vaccine on children, and I finish the article with 3). a summary, for the general public, called community immunity: how vaccines protect us all. 1). Haiti: Cholera Vaccines One Possible Option For Preventing More Outbreaks October 20, 2011 Haiti was hit with a massive epidemic of cholera, a disease not seen in the country for perhaps a century, in October 2010. The causative pathogen, Vibrio cholera-variant O1 Ogawa-has been imported and introduced by human activity. The numbers of infected people across Haiti reached their peak by the last week of 2010, when over 4,000 cases of cholera were reported daily, according to the Haitian Ministry of Health. Subsequently, the number of cases declined slowly until the end of April 2011, with 500 cases reported daily. A second rise was reported and reached a peak in mid-June of 2,000 cases per day. As of October 2011, more than 464,000 cases and 6,500 deaths have been recorded. Cholera transmission in Haiti is now in its twelfth month and some communities are being affected for a second time. The consensus is that cholera has taken up a long-term, if not permanent, environmental presence in the country, and as such, the reinforcement and expansion of preventive measures has become vital. Dr. David Olson, Doctors Without Borders / Médecins Sans Frontières (MSF) medical advisor for diarrheal diseases, has been involved in MSF's response to the epidemic from the beginning. Here he answers questions about the possibility of using cholera vaccines to address these needs. What are the vaccination options available today against cholera? Vaccines against cholera have existed for decades, first in injectable form used by travelers and the military. However, its side effects and limited effectiveness have made it inappropriate for mass vaccinations, and they are almost never used. More recently, oral vaccines (OCVs) have been developed and trialed in cholera-endemic settings. They have proven to be effective and virtually free of serious side effects. Though protective immunity seems to wane after two to three years, the World Health Organization (WHO) has recommended OCVs as one prevention tool, in addition to water and sanitation measures, for over 10 years. Currently, there are two OCVs available: Dukoral, which is manufactured by biopharmaceutical company Crucell, has been on the market for over 20 years; and Shanchol, made by Shantha Biotech, was recently pre-qualified by the WHO. Both medicines require two doses, given two weeks apart, conferring immunity seven days after the second dose. Clinically speaking, one is not better than the other in terms of protective efficacy, which is about 70 percent over two years, as seen in clinical trials. However, Dukoral has to be mixed with a buffer before being swallowed, while Shanchol is just a couple of milliliters of solution that can be dropped into the mouth like a polio vaccine. Logistically, the latter would be easier, and it would be affordable at around $2 per dose. Source: http://www.doctorswithoutborders.org/news/article.cfm?id=5569&cat=field-news 2). Anthrax, the Disease Anthrax is an illness caused by bacteria called Bacillus anthracis. These bacteria are found naturally in the soil. They can form a protective coat around themselves called spores, and they can release poisonous substances into the bodies of infected people. You and your children cannot catch anthrax from each other or from any other person. Even if you were to become sick with anthrax, you could not pass on the illness to your children. Also, even if someone were to put the bacteria that causes anthrax in your workplace on purpose, it is highly unlikely that you would carry the bacteria home to your children on your clothes or hair. There are three types of anthrax, each with different symptoms: Cutaneous, or skin, anthrax is the most common form. It is usually contracted when a person with a break in their skin, such as a cut or abrasion, comes into direct contact with anthrax spores. The resulting itchy bump rapidly develops into a black sore. Some people can then develop headaches, muscle aches, fever and vomiting. Cutaneous anthrax must be treated quickly. Appropriate medical evaluation and treatment are essential. Gastrointestinal anthrax is caught from eating meat from an infected animal. It causes initial symptoms similar to food poisoning but these can worsen to produce severe abdominal pain, vomiting of blood and severe diarrhea. Appropriate medical evaluation and treatment are essential. Inhalation or pulmonary anthrax the most severe form of human anthrax. Though the rarest, it is the form of human anthrax causing the most current concern. This form of the disease is caused when a person is directly exposed to a large number of anthrax spores suspended in the air, and breathes them in. The first symptoms are similar to those of a common cold, but this can rapidly progress to severe breathing difficulties and shock. Appropriate medical evaluation and treatment are essential.  | |
Source: http://www.theblaze.com/stories/could-the-feds-soon-test-anthrax-vaccine-on-your-kids/
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Anthrax responds well to antibiotic treatment. Antibiotics must be prescribed and taken with medical advice. Nobody should attempt to use antibiotics or any other drugs to treat or protect themselves without first getting medical advice. Source: BioThrax® (Anthrax Vaccine Adsorbed) BioThrax is the only FDA-licensed vaccine available for pre-exposure protection against anthrax infection To date, more than 10 million doses of BioThrax® (Anthrax Vaccine Adsorbed) have been administered to more than 2.5 million individuals (adults). BioThrax is indicated for the active immunization of individuals between 18 and 65 years of age at high risk of exposure to anthrax. BioThrax is not licensed for use in a post-exposure setting. The safety and efficacy of BioThrax have not been established in pregnant women, nursing mothers, pediatric populations or geriatric populations. Source: http://www.biothrax.com/whatisbiothrax The anthrax vaccine is given in 5 doses (in the muscle): the first dose when risk of a potential exposure is identified, and the remaining doses at 4 weeks and 6, 12, and 18 months after the first dose. For more information on the anthrax vaccine and dosing from the Centers for Disease Control click on the following link. BiodefenseGovernment Considers Testing Anthrax Vaccine on Children Published 26 October, 2011 Overview: The U.S. government is considering testing its anthrax vaccine (which strains of anthrax does the vaccine protect against?) on children to determine if it has any potential side effects; so far, the government's anthrax vaccine has only been tested on adults. (Does the children's vaccine still involve multiple doses?) The members of the National Biodefense Science Board (NBSB) argued that there had been no tests to determine the effectiveness of the vaccine on children. Opponents of the suggestion have sharply criticized it on the grounds that it is unethical to test a vaccine on children especially if there is no immediate threat. Proponents of testing the vaccine acknowledged the criticism, but maintain that it is critical to ensure the safety of the vaccine on children in the event that it had to be administered. Thus far, there have been no tests to determine the effectiveness of the vaccine on children. Source: http://www.theblaze.com/stories/could-the-feds-soon-test-anthrax-vaccine-on-your-kids/ Proponents According to Dr. Nicole Lurie, the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, waiting until a national crisis to use the vaccine for the first time would be problematic as it presents "an array of logistical, clinical and communication challenges during a public health crisis." Daniel B. Fagbuyiof, of the Children's National Medical Center in Washington and the chair of NBSB, echoed Dr. Lurie's thoughts stating, "At the end of the day, do we want to wait for an attack and give it to millions and millions of children and collect data at that time? Or do we want to say 'how do we best protect our children?'" "We can take care of grandma and grandpa, uncle and auntie. But right now, we have nothing for the children," Fagbuyiof said. So far, the anthrax vaccine has been thoroughly tested on adults and more than 2.6 million members of the armed forces have been inoculated, but the government lacks data on how well the vaccine works on children and if it is safe. Opponents Opponents of the suggestion have sharply criticized it on the grounds that it is unethical to test a vaccine on children especially if there is no immediate threat. "It's hard to believe that it's something that makes a great deal of sense," said Joel Frader, a bioethicist with the Northwestern University Feinberg School of Medicine. "It would be difficult to justify testing it on kids simply on the hypothetical possibility that there might be an attack." Dr. Lurie acknowledged the criticism, but maintained that it was critical to ensure the safety of the vaccine on children in the event that it had to be administered. "If you had a situation where a vaccine has never been given to a child, it's pretty hard to think what you could say to people about its safety and efficacy," she said. "To be honest, the safest and easiest thing to do would be to not make a decision and kick the can down the road," Lurie said. "But it seemed to me that would be socially irresponsible. I would hate for a lot of children to die because we didn't have enough information for the public to feel comfortable getting [the] vaccine." Next Steps The National Biodefense Science Board (NBSB), a group of federal advisors, convened last month specifically to debate the issue; the board is set to meet again on Friday to vote on its controversial recommendation. . . . Source: http://www.homelandsecuritynewswire.com/government-considers-testing-anthrax-vaccine-children . . . The National Biodefense Science Board recommends that the government sponsor a controversial study to test the anthrax vaccine in children. Anthrax: Although an overwhelming majority of the panel endorsed conducting a study, several critics said such tests would be unethical, unnecessary and dangerous. The federal government has spent $1.1 billion to stockpile a vaccine to protect Americans in the event of an anthrax attack. The National Biodefense Science Board, which advises the federal government on issues related to bioterrorism, voted 12-1 to recommend that the Health and Human Services Department move forward with a study aimed at determining whether the vaccine is safe and effective in children and identifying the best dose. Patricia Quinlisk of the Iowa Department of Public Health, who is chairwoman of the panel, was the only dissenter. "We need to know more about the safety and immunogenicity of the vaccine as we develop plans to use the vaccine on a large number of children in the event of a bioterrorist's attack," said Ruth Berkelman of Emory University, a panel member. The panel adopted Berkelman's suggestion that the study undergo further review by another panel to specifically examine the difficult ethical concerns it would raise. Nicole Lurie , assistant HHS secretary for preparedness and response, who requested the panel's review, said officials would consider the panel's recommendation, but she did not give a time frame for a decision. Source: http://www.mnn.com/health/fitness-well-being/stories/anthrax-vaccine-needs-further-testing# Here is some additional information to help understand the important public health role that immunization plays in disease control. 3). Community Immunity: How Vaccines Protect Us All Parents know that kids are vulnerable to a host of infectious diseases. Research supported by the National Institute Of Health (NIH) and others propose that the benefits of vaccines in preventing illness and death greatly outweigh the risks. The list of childhood diseases can be overwhelming: measles, mumps, rubella, diphtheria, pertussis, polio, meningitis, influenza and rotavirus. In the era before vaccines, many children in the U.S. died or became disabled from these diseases. Many still do in countries and regions with lower vaccination rates. With all the international travel in the world these days, it's important to keep vaccines, or immunizations, up to date. Here's just one example of what might happen if you don't. By 2000, immunization had practically wiped out measles in the U.S. But a measles outbreak in 2005 was traced to one unvaccinated U.S. resident infected during a visit to Europe. The returning traveler infected American children who hadn't been vaccinated because of safety concerns-despite study after study showing that childhood vaccines are safe and effective. A major epidemic didn't emerge that time. That's because enough people in the surrounding communities had already been vaccinated against measles. "The important concept," says Dr. Marc Lipsitch of the Harvard School of Public Health, "is that vaccinating people protects not only them, but others in the community. If I'm protected, I can protect others." This type of protection is known as "community immunity" or "herd immunity." When enough of the community is immunized against a contagious disease, most other members are protected from infection because there's little opportunity for the disease to spread. Newborns, pregnant women or people whose immune systems are weakened may not be eligible for certain vaccines. Yet even they will get some protection because the spread of contagious disease is contained. "Epidemiologists think of infections as chain reactions, whose speed depends on contagiousness," says Lipsitch. "The more contagious the disease, the more vaccination is required. The data tells us that herd immunity works." Using mathematical formulas and computer programs, NIH-funded scientists like Lipsitch have developed models to determine what proportion of the population has to be vaccinated to eliminate the spread of disease. As one example, a worldwide vaccination campaign completely eliminated, or eradicated, smallpox in the 1970s. So many people were immunized that the virus couldn't sustain itself. More recently, infant vaccination against Haemophilus influenzae type b (Hib, which can cause meningitis) lowered the risk of disease in the whole population. Before the vaccine, Hib struck about 1 in 200 children younger than age 5. It killed many and often left survivors with permanent brain damage. After the Hib vaccine was introduced in the mid-1980s, the incidence of Hib dropped by 99%. "Infectious disease eradication is possible," says Lipsitch. Even when a disease-such as measles or Hib- hasn't been completely wiped out, immunizations can reduce disease transmission, so that epidemics become less frequent. When parents choose to immunize, they're helping more than their own. Make sure your child's immunizations are up to date. And talk with your child's doctor if you have any concerns about vaccine safety. Source: http://newsinhealth.nih.gov/issue/Oct2011/Feature2 Separate article . . . Why Disgust Can be Good for Us in a Disaster. "Disgust" is our first line of defense in a disaster against disease. . . Generations of disgust have refined our ability to survive. Something to think about! Below, Dr. Val Curtis explains why "disgust" can be harnessed to combat behavioral causes of infectious and chronic disease. We tread very lightly in promoting the idea as it can be used easily in a negative manner. It is my intention to talk only about the positive uses of this disease prevention technique in a massive disaster when regular medical assistance in not accessible to guide and care for us. So, please be open-minded to only the positive aspects of this disaster, disease prevention method. "Why disgust matters" by Dr. Val Curtis, Philosophical Transaction of The Royal Society B The new synthesis about disgust is that it is a system that evolved to motivate infectious disease avoidance. There are vital practical and intellectual reasons why we need to understand disgust better. Practically, disgust can be harnessed to combat the behavioral causes of infectious and chronic disease such as diarrheal disease, pandemic flu and smoking. Disgust is also a source of much human suffering; it plays an underappreciated role in anxieties and phobias such as obsessive compulsive disorder, social phobia and post-traumatic stress syndromes; it is a hidden cost of many occupations such as caring for the sick and dealing with wastes, and self-directed disgust afflicts the lives of many, such as the obese and fistula patients. Disgust is used and abused in society, being both a force for social cohesion and a cause of prejudice and stigmatization of out-groups. This paper argues that a better understanding of disgust, using the new synthesis, offers practical lessons that can enhance human flourishing. Disgust also provides a model system for the study of emotion, one of the most important issues facing the brain and behavioral sciences today. Why feeling disgust can be good for us . . . From October 31, 2011 BBC News Health Report Disgust at uncontrolled sneezing, for example, is one of our main defenses against infection. The facial expression for disgust is universal. We can all picture the contorted, horrified face, which communicates a feeling of revulsion and loathing. Spiders, slimy creatures, mucus and feces can all provoke this feeling. Our reaction is to distance ourselves from the cause. As a result, feelings of disgust help us to avoid, or at the very least recognize, the things that make us feel this way - and for a very good reason, psychologists say. When it comes to infectious diseases, disgust has evolved to help us steer clear of sick people, dirty water, vomit, body fluids and all the other stuff that makes us react "Yuck." In a paper published in Philosophical Transactions for the Royal Society B, Dr. Val Curtis, from the London School of Hygiene and Tropical Medicine, argues that avoidance behavior is essential to prevent the spread of all the major current and recent infectious diseases which present a threat to humans. Diarrheal diseases, respiratory tract infections, malaria, measles, HIV, tuberculosis and parasitic worms can all be avoided by thinking about aspects of hygiene, Dr. Curtis says. "The idea of contacting or consuming infectious substances such as saliva, feces or vomit, or of intimate contact with those known to be carrying infection is deeply uncomfortable to even contemplate," writes Dr. Curtis. "Self-limitation of such behavior is so automatic and intuitive that it is often ignored as the front-line in our defense against disease." "We only develop an understanding of disgust around the age of two or three years old." Prof Graham Davey of the University of Sussex, United Kingdom states: "Washing hands and food can prevent diseases like cholera and hepatitis A, while keeping a distance from people with influenza or measles is a sensible move to reduce the risk of infection." Major features of infectious disease that illicit disgust: - Diarrheal diseases - feces, dirty water, contaminated food, vomit
- Hepatitis - feces, dirty water, contaminated food, vomit
- Leprosy - skin lesions, nasal mucous
- Measles - rash, sores, nasal and throat secretions
- Plague - pustules, sick people, refuse, rats, fleas
- Rabies - saliva, infected animal, dog, bat
- Syphilis - rash, skin lesions, especially on genitals, insanity
- Tuberculosis - nasal mucous, spittle, droplets, stale air
Go forth and "disgust" appropriately in a disaster but not as a cause for prejudice and stigmatization. | 
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On November 9, 2011 at 2:00 p.m. Eastern Standard Time the Federal Emergency Management Agency (FEMA), the Federal Communications Commission (FCC) and the National Weather Service (NWS) branch of the National Oceanic Atmospheric Association (NOAA) teamed up to conduct the first nationwide test of the Emergency Alert System (