Welcome! This is the eleventh post in my vaccine series. Today we are going to talk about the Pneumoccocal, HPV, and Meningococcal Vaccines. If you have missed any part of the series, catch up with these posts: 10 Bad Reasons Not to Vaccinate, Why “Science” Should Be Carefully Evaluated, What is Herd Immunity All About, How the Immune System Works, Ingredients in Vaccines Part 1, Ingredients in Vaccines, Part 2, Risk-Benefit Analysis: MMR, Risk-Benefit Analysis: DTaP or Risk-Benefit Analysis: Chicken Pox, Hib, Flu.
Today we continue on our risk-benefit analysis. Somehow, I can’t believe that it takes me five posts to get through all of these…there are 15 diseases that we “normally” vaccinate against, plus additional ones sometimes? That seems like way too many!
Anyway. Let’s dive in!
What is pneumococcal?
This is a disease that causes bacterial pneumonia, meningitis, and bacteremia, which are more serious in small children and the elderly. Between 5 and 70% of people are asymptomatic carriers of this bacteria. It is not known if being a carrier creates immunity in the person. Pneumonia is traditionally treated with antibiotics like penicillin, but this is not always effective, which is why the vaccine was developed.
There are 90 types of this bacteria, but just 10 of them are responsible for over 60% of infections.
Outbreaks are uncommon and mostly occur in closed settings like childcare facilities or nursing homes. Prior to vaccine use, the case incidence was just 167 per 100,000 per year in the U.S. Most cases occur in children under age 2.
Risk factors include lack of exclusive breastfeeding, indoor air pollution, and nutritional deficiencies.
Normal course of illness
Incubation is short — 1 to 3 days. Onset is sudden and includes fever, chills, productive cough (producing rusty sputum), shortness of breath, rapid breathing, fatigue, and weakness. Occasionally, headaches, nausea, and vomiting will occur.
This bacteria can also cause sinus infections and ear infections more commonly (although since testing for the specific strain of bacteria for these milder infections usually doesn’t occur, it is hard to say how often this strain causes these illnesses).
For pneumonia, the case fatality rate is 5 – 7%, and approximately 175,000 hospitalizations occur each year.
For bacteremia (which can occur with pneumonia), the fatality rate is about 20%, and there are 50,000 hospitalizations each year.
For meningitis, the fatality rate is about 30%, and there are 3000 – 6000 cases per year. It is the cause of up to 20% of all bacterial meningitis cases (the pneumoccocal strain).
After enduring this infection, nearly 60% of patients may have one of the following: hearing loss, mental retardation, motor abnormalities, or seizures.
An estimated 200 children died each year of this disease before vaccine use.
The vaccine that is currently recommended in the US is usually referred to as PCV-13 (because it contains 13 different strains). This is a conjugate vaccine.
There were 4110 adverse effects reported to VAERS in 2011. (Remember that it is estimated that between 1 and 10% of all side effects are actually reported.) 488 of these (or a bit over 10%) were considered serious. These include rash, fever, seizures, swelling, vomiting, headache, soreness, inconsolable crying, headache, stiff neck, and more.
VAERS reports 45 deaths from the vaccine in 2011.
This can be a scary disease, but it seems much more likely to occur in children who are not breastfed, are nutritionally deficient, or have an underlying condition. It is not common in other populations. It has never been an “outbreak” disease. It has never caused significant complication or death rates, at least not among children (it does in the elderly).
The vaccine has a high rate of reactions and a significant percentage are serious. As reported to VAERS, 25% as many children die from the vaccine as the disease (and if this reporting is as low as estimated, then more children die of the vaccine than the disease). It is extremely important to protect children by breastfeeding, avoiding large childcare centers if possible, and feeding a healthy diet.
What is HPV?
HPV, or human papillomavirus, is a sexually-transmitted disease that can, in some cases, lead to cervical cancer. This vaccine isn’t on the infant schedule (currently), but is now recommended for both girls and boys as pre-teens. There have been some attempts to add it to the infant schedule, however, but nothing concrete has been said.
There are over 100 strains of HPV that have been identified. Types 16 and 18 are “high risk” types that are present in 70% of all cervical cancer cases. It is considered necessary to develop HPV in order to develop cervical cancer, although having HPV does not necessarily mean one will have cervical cancer (i.e. cancer doesn’t occur without HPV, but HPV can occur without cancer). The vast majority of women who do have HPV will not get cancer.
Normal course of illness
HPV infection happens at the basal epithelium (on the cervix). It is transmitted through sexual contact. Most of these will resolve spontaneously, and not cause any chronic infection or further issues. For the most part, there is no clinical disease or symptoms. Risk factors include number of sexual partners, promiscuous behavior, smoking, and inconsistent condom use.
A small number will go on to experience chronic infection. 5 to 30% will have multiple strains. Low-risk types 6 and 11 are responsible for 90% of genital warts.
In some rare cases, genital warts or different types of cancer can occur. About 11,000 cases of cancer related to HPV occur per year, and nearly 4000 women will die.
Vaccine is recommended in boys and girls ages 9 – 24, and requires three doses. It contains protection against strains 6, 11, 16, and 18 (Gardasil). Another vaccine protects against 16 and 18 (Cervarix). Protection lasts about 5 years.
There were 1470 reports to VAERS in 2011. These included fainting, redness, swelling, headache, fatigue, nausea, blindness, chronic joint pain, vomiting, appendicitis, seizures, pancreatitis, diabetes, cancer, death, and more. 94 of these were serious.
This vaccine has been reported as incredibly dangerous, with many girls fainting and some left with permanent damage to their bodies, and some girls dying. Since HPV is easily preventable by avoiding sex with multiple partners, taking appropriate precautions in this area seems far wiser than getting this vaccine. Additionally, the vast majority of HPV infections do not lead to any serious problems. Pap tests every 2 – 3 years to check for abnormal cells are a safer idea than this vaccine.
What is meningococcal?
This is a type of bacteria that causes an illness called meningitis, an inflammation in the meninges in the brain. This can be very serious and can cause permanent damage or death. It is, however, relatively rare. Until recently, this vaccine was only recommended for college students, but is now on the infant schedule.
Normal course of illness
The majority of people who are colonized with this bacteria will not get sick at all — less than 1% will develop any symptoms. Of those who do, about 50% will actually end up with meningitis (less than 0.5% of those who “catch” the bacteria).
The incubation is 3 – 4 days typically, with a range of 2 – 10. Meningitis is the most common infection that results, but in up to 20% of cases, meningococcemia or sepsis (an infection of the bloodstream) occurs. Also possible, but less likely, are pneumonia, ear infections, arthritis, and epiglottitis (infection of the epiglottis in the throat).
Symptoms include poor appetite, fever, irritability, fatigue, nausea, vomiting, diarrhea, photophobia (light sensitivity) and convulsions. A hemorrhagic rash is characteristic.
Death occurs in 9 – 12% of meningitis patients. Meningococcemia may cause death is up to 40% of cases.
Up to 20% of patients who survive may have hearing loss, loss of limbs, neurological damage, or other permanent damage.
This vaccine is “recommended” for high risk groups starting from 9 months of age. Two doses are recommended at least 8 weeks apart. Not all infants will receive this vaccine. Length of protection is unknown.
According to the package insert (Menactra), greater than 10% of recipients had fever, soreness, swelling, irritability, abnormal crying, drowsiness, appetite loss, vomiting. There is some evidence that conjugate vaccines (including this, Hib, and pneumococcal) have been linked to increased rates of autism because of the way they work, their ability to produce a much stronger reaction than normal and that these infections are brain-based.
According to VAERS, there were 1541 adverse events reported in 2011. These include nausea, fever, fainting, seizures, neck pain, diarrhea, Guillain Barre, headache, rash, diabetes, death, and more. 45 were classified as “serious,” or about 3%. (Fainting episodes were not classified as serious, but occurred about 6% of the time.)
This vaccine is really recommended for “high risk” groups. Most babies will be protected by their mother’s antibodies. As usual, maintaining a healthy lifestyle will be highly protective for most people. Those with immune deficiencies are most at risk. The vaccine itself has quite a few adverse reactions and given the rare nature of the infection, is probably not worth it.
As always, I caution you to ask questions of your doctors before accepting any treatment, and ask to see the package inserts. If the doctor cannot produce them or is unwilling or unable to answer your questions, skip the vaccines at that visit and find someone who can do this. Take into consideration your particular situation when making decisions and be sure to read through the links provided within the text for more information.