Vaccines and MeNZB
There's a big anti-vaccination movement around at the moment, and I think it's ill-advised and extremely unhelpful to society.
I recently had a friend die of Meningococcal disease. Not a very close friend, to a person I know she was like a second daughter, well by analogy she was to me like a second cousin I saw at larger family gatherings.
However as she died at a ridiculously young age and was otherwise in good health, I found it somewhat disturbing and so started to research on this phantom menace disease. I knew little about it other than it must be one of those classes of disease which infect the dorsal cavity (the surrounding of which is called the meninges) which contain the spinal cord and brain.
A scanning-electron microscope (I assume) picture of N. meningitidis
Turns out, that there was a New Zealand epidemic of this disease caused by a bacterium ( Neisseria meningitidis) which, according to the Wikipedia article on it, is found in 5-15% of adults. Quite how it goes from being apparently harmless flora in the throat to infecting the blood and meninges is still a mystery.
So this means that the disease can be controlled in two, perhaps three ways: firstly by controlling the spread of the flora by getting people to be more aware of things like sharing saliva and handwashing, to reduce the chances that you have any of the disease in your throat. Secondly, you can immunise, so that if the bacterium does get into your bloodstream, your immune system has a better chance to repel it in time. Lastly, anything to boost the general health of the immune system might help.
A picture from Nature showing N. meningitidis is gram negative
There are many groups of the disease, A, B, C, W135, X ... most of these have simple, cheap polysaccharide vaccines and a new conjugate vaccine for type A has recently been developed. These are relatively low-cost and are used in African countries.
However the New Zealand outbreak was primarily group B. So, this requires a more technical counter where you basically have to strip the bacteria of their outer membrane vesicles, mix those outer bits with some adjuvant and a buffer solution, then dilute the whole lot in saline. When injected, it will usually stimulate the immune system into fighting an easy fight against the tiny pieces of the bacteria - an in doing so, tool them up to be able to fight the real thing should it ever have to.
Structure of the meningococcal cell wall. Capsular polysaccharides and outer membrane proteins are the target of ongoing vaccine research. (from chori.org)
It's not 100%. Perhaps for practical reasons they had to select a single dominant strain. It can go wrong in a number of places. The immune system might not respond to the vaccine and so immunity might not be conferred. This is a common misunderstanding, people have this assumption that once you get the shot you are immunised for life and if you catch the disease then the immunisation must be a fraud.
Fighting epidemics is fighting statistics. It's frustrating because it's very hard to see if it worked, and if you are trying multiple approaches, which one was more effective. To get the most benefit, when there is an epidemic, you target the vulnerable group - in this case, people who are likely going to be swapping saliva with the most number of different partners intentionally or inadvertently - in this case, under 30's.
This graph comes from an anti-vaxxer, but note the sharp drop in incidence as the vaccination is more widely taken up.
That doesn't mean that such statements imply that people who die of this dreadful disease were swapping saliva more than any other person. It doesn't mean that when I call for wider immunisation that I am casting aspersions on the parents of my friend. She was immunised. Everyone says shining things about her.
What I'm calling for is co-operation with the medical field and people to stop passing around these poorly founded arguments against vaccinations, for it helps no-one to simply give up on one of our key approaches to combating epidemics.
In particular, if you are the sort of parent who chooses not to immunize, because of fears about a minor rash or because it's not 100%, you are detracting from the value of the immunization programme. You are detracting far more than the share of the population represented, you include a percentage of the people they come into contact with. That's the network effect in reverse. It gets shittier the more people who opt out.
I'm angry at the 17% of parents who said NO to the programme. I'm
angry at
the one third
of NZ health professionals who think there is a link between Autism
and MMR vaccine but are too lazy to research for the benefit of
spreading better information. I'm angry
at Sue
BradfordKedgeley for supporting the anti-vaccination cause.
I guess my main point is that the argument against vaccinations that says that we shouldn't immunise, because you know children need a few good diseases to harden themselves up, pretty much falls flat when those diseases cause sudden death. Worrying about vaccine side-effects or big pharma conspiracies is a First-World Problem, and acting on them has a cost in blood.
Wild-Type Outer Membrane Vesicle Vaccines
Vaccines. They're putting hobbled viruses and bacteria into our system so that they can cause an infection, and thereby build an immunity, right? Like Smallpox and Cowpox, right?
Well, sometimes. That is called a Live Attenuated vaccine. They're difficult to manage and relatively high risk.
There are many different types of vaccine, all of which involve hobbling the rogue organism to different degrees.
If they get cooked, nuked (that is, sterilized in an irradiation facility such as the one in Upper Hutt), or perhaps killed with strong salt, acid, base, or some such - then it's called an inactivated vaccine. These are a step up.
They still work, even though the vaccine or bacterium does not cause an infection. They do not replicate in the body. Any reaction that occurs, will be an immune response only. All that means is that your immune system is responding to the foreign matter, like it is when you get a pimple or your hayfever plays up.
A vesicle is a little bubble of cellular membrane. It has all of the external markers or antigens, without the dangerous bacterium inner.
A step up again from an inactivated vaccine is a sub unit vaccine. If you, through chemical manipulation, extract just a part of the organism - then you have the safest known approach to creating vaccines today. They are lower in side effects, easier to manage (as there is no live agent to keep alive), although as a real infection does not occur, several shots are needed to provide immunity. If there was a "real" infection, it would provide the body with a steady stream of greeblies to fight.
The type of vaccine used for Mengingococcal disease (group B, the type causing NZ's epidemic since 1991) is called wild-type outer membrane vesicle or wtOMV in the medical literature.
It is something of a testament to the success of modern medical science that society demands almost perfect results from it. But these are relatively early days for the wtOMV approach. It is extremely specific and targeted to a particular strain of a disease. It may not provide indefinite protection; but through testing it can be shown that it can provide protection for long enough to stop an outbreak.
Scientists are working on this. I read with interest the abstract of a paper on the performance of vaccines including MeNZB:
There is good reason to believe that in the coming few years the “OMV-concept” will be exploited further and that a number of cross-protective “universal” antigens will be included in vaccines against serogroup B meningococcal disease.
This is extremely promising. We're not there yet, and so when vaccines didn't work 100%, it's a good idea not to start hating on the scientists or the institutions supporting them. I mean, certainly make them work for their money and stuff but don't forget that most of these scientists are simply motivated individuals who want to use their talent and skills to make a difference. Look at the far-flung institutes that produced that paper: Norwegian Institute of Public Health, Oslo, Norway; Institute of Environmental Science and Research, Porirua, New Zealand; Victoria University, Wellington, New Zealand; Finlay Institute, Havana, Cuba; Novartis Vaccines & Diagnostics, Siena, Italy; Ministry of Health, Wellington, New Zealand. That in itself speaks volumes about the independence of their work.
Why is the MeNZB Immunity only Temporary?
Humoral Immune Response is shown here; other forms of defence include innate immunity (a wide category including everything from enzymes in tears to the skin) and phagocytosis.
The full picture of immunity is quite a complex picture; but nonetheless it is well known; one of the things that was certainly very striking to me as I was studying First Year Anatomy & Physiology was the level of detail that science knows. I was quite surprised to know how much information was known, even in the decade-old book I was using as a text.
But basically, immunity is only permanent if it goes through a particular stage of the immune response. I won't pretend to remember the intricate details, but in essence you don't get the strongest protection without a real infection, and real infections present the greatest danger - perhaps death with some diseases.
What about averse reactions?
You might already be primed to attack that material being injected to you. You might already have acquired immunity, in which case the reaction will be much more immediate - your system knows these foreign particles and the alarm bells go off. This will cause a reaction.
This is especially the case with N. meningitidis. It is considered normal flora in your throat - 5-15% of people are expected to have it. The throat has an organ called the tonsils which allow the body to prepare itself for infection by fighting the bacteria in the food you eat. So, it's quite expected that a good number of people will already be immune and therefore elicit a stronger immune response.
But it's temporary, and links between vaccine responses and autism have been not only debunked but revealed as fraudulent. Don't let yourself be duped!
What about breast feeding?
For the first 6-12 months of your life, you have antibodies (one mechanism of immune response) floating in your blood which were transferred from the mother. This is called innate immunity, but these antibodies are not transferred via breast-milk; the baby's digestive system will destroy them before they can!
It's all a vast Big Pharma conspiracy!
For a start, pharmaceutical companies are probably actually undermining their medium-term takings by producing vaccines. Wouldn't it be cheaper for them not to produce them at all, and instead sell us remedies when we fall sick?
I have very little time for complaints like this in New Zealand, where there is Pharmac for bulk purchasing power. I just don't believe that the staff at Pharmac - some of whom I have known and talked to in the past - can be duped by sales execs or that the independent monitoring panels would fail to pick anything up.
That said, I certainly disagree with direct to consumer marketing, and from a macro-economic perspective, the pressure from maintaining high profit margins by our current implementation of capitalism can appear (and often even be) sinister.
The fight against these diseases is the raw fight for existence, which in modern times is already stepping outside of our frames of reference. We need concerted action on this, not half-hearted. It's a war-scale effort - don't defect to the enemy!