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Vaccines: A public health success story

Tech Sgt. Joseph Anthony, medical technician with the 911th Aeromedical Staging Squadron, administers a vaccination to a member of the U.S. Army Reserve’s 336 Engineering Company Command and Control, Chemical Radiological and Nuclear Response Enterprise Team at the Pittsburgh International Airport Air Reserve Station, Pennsylvania, April 11, 2019. Department of Defense-issued vaccinations are used to prevent a variety of diseases that military members may encounter in the course of their duties. (U.S. Air Force photo by Joshua J. Seybert) Air Force Tech Sgt. Joseph Anthony, medical technician with the 911th Aeromedical Staging Squadron, administers a vaccination to a member of the U.S. Army Reserve’s 336 Engineering Company Command and Control, Chemical Radiological and Nuclear Response Enterprise Team at the Pittsburgh International Airport Air Reserve Station, Pennsylvania, April 11, 2019. Department of Defense-issued vaccinations are used to prevent a variety of diseases that military members may encounter in the course of their duties. (U.S. Air Force photo by Joshua J. Seybert)

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Throughout U.S. history, people have benefited from improvements in the field of public health. The availability of clean water, the development of sewage systems, and other effective interventions worked to cut the rate of disease in entire segments of the population at relatively low cost. Vaccination is an intervention that has proved effective in terms of cost and effort in protecting the population from disease.

Individuals clearly benefit from the disease protection offered by vaccinations. In addition, if vaccination levels are high enough within a population, protection may be extended to those unable to be vaccinated, either due to a medical restriction or because they are too young. This is because without enough susceptible individuals acting as “carriers,” the disease can’t effectively be transmitted from person to person. The ideal situation is when the disease is eradicated. This has only happened once in recorded human history, with smallpox. We need enough participation in vaccination programs so both individuals and society can enjoy the benefits of freedom from disease.

As a scientist, the recent backlash against vaccines and decision by some parents not to have their children vaccinated concerns me. The use of vaccines is a societal process of risk and benefit, not only for individuals but for everyone. We have a basic tenet in society: balancing an individual’s right to choose with that person’s duty to protect him or herself, any children, other loved ones, and society as a whole.

Some of the information circulating in today’s media about vaccines isn’t scientifically based; instead, it’s based on emotion. Measles was declared eliminated in the United States in 2000 because people were vaccinated against it at such high rates that there was no continuous disease transmission. Measles is now making a comeback as a substantial portion of the population has chosen not to be vaccinated against it. Approximately 1 per 1,000 individuals who gets measles will have a serious adverse outcome that can include life-long disability or death. Neurological complications can occur from measles – it’s a potentially dangerous disease that’s completely preventable.

A complicating issue for society is that some individuals who would normally take a vaccine for some diseases can’t be vaccinated for medical reasons. They’re either too young or have an immune deficiency or some other limiting factor. These people are now being exposed to unnecessary risk by others who have declined to take a vaccine because they have a belief against it for whatever reason.

Of course, measles isn’t the only disease that can be controlled by vaccinations. Others include:

Mumps. We know that mumps often doesn’t cause as many problems as measles long term, but mumps does have serious potential consequences. There was a recent outbreak of mumps among active-duty personnel. This is likely because the mumps portion of the MMR vaccine isn’t as effective initially as the measles or rubella portions, and even in those who have an initial immunity to mumps, the protection declines more rapidly than the other portions over time. There’s no current recommendation or policy to revaccinate people against mumps, except during a mumps outbreak, so mumps still occurs.

Whooping cough (pertussis). This disease more often causes complications and serious diseases in children. We have policies for certain DoD-run activities, such as day care centers, requiring individuals to be vaccinated against pertussis. The policies were put in place primarily because of the potential for children to spread it to other children, with potentially serious complications.

Hepatitis A. This disease is most commonly transmitted through contaminated food or water. It is currently a routine childhood vaccine. We vaccinate all service members for hepatitis A.

Influenza. Every year we offer an influenza vaccine. We require all service members to get it, and we offer it to all beneficiaries. The “flu shot” is especially important for populations targeted by CDC as “higher risk,” including children from six months to about 9 years of age and pregnant women. The CDC has recommended that everyone get the vaccine, but public health professionals struggle to reach a rate as high as 50 percent. Other than for service members, the decision of whether or not to receive the influenza vaccine remains with the individual. While we provide guidance and counseling to assist them, the individual must balance any concerns about the vaccine with the potential benefits of not getting flu.

Additional vaccinations are critical in the military, beginning in basic training when large numbers of individuals from around the country are housed together. The adenovirus vaccine is given because this upper respiratory infection can cause significant lost time during training, and on rare occasion it can have more severe consequences, including death.

Other vaccines are required for military personnel because of their occupations or the potential risks they might face – like anthrax and smallpox. Some vaccines are given to warfighters as protection against diseases we don’t worry about in the United States; these diseases, including meningitis and yellow fever, cause problems elsewhere. Our service members must be as ready as possible at all times, and a medically ready force must be free of potentially disabling and disability-producing diseases. At this time, vaccines are among the most effective tools we have to reduce the risk of a service member acquiring a preventable disease.

Regarding vaccines, the military follows Centers for Disease Control and Prevention guidelines for the general population, except in the specific cases just mentioned where vaccines are required for military reasons.

In a sense, the effectiveness of vaccines to control and eliminate diseases causes a problem: Vaccines are a victim of their own success. Many people think they don’t need to protect themselves anymore, that the diseases eradicated here are now somebody else’s problem in another part of the world. The current measles outbreaks demonstrate the flaw in this reasoning. Our emphasis in public health in general is that vaccines are good, and the need for them is ongoing. The vaccines we use are proven safe and effective. Any risk from a vaccine pales in comparison to the benefit to the individual and to society. The scientific evidence is clear: Vaccines are a public health success.

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Each year, the Department of Defense (DoD) Global, Laboratory-based Influenza Surveillance Program performs surveillance for influenza among service members of the DoD and their dependent family members. In addition to routine surveillance, vaccine effectiveness (VE) studies are performed and results are shared with the Food and Drug Administration, Centers for Disease Control and Prevention, and the World Health Organization for vaccine evaluation. This report documents the annual surveillance trends for the 2016 – 2017 influenza season and the end-of-season VE results. The analysis was performed by the U.S. Air Force School of Aerospace Medicine Epidemiology Laboratory, and the DoD Influenza Surveillance Program staff at Wright-Patterson Air Force Base, OH. FINDINGS: A total of 5,555 specimens were tested from 84 locations: •	2,486 (44.7%) negative •	1,382 (24.9%) influenza A •	1,093 (19.7%) other respiratory pathogens •	443 (8.0%) influenza B •	151 (2.7%) co-infections The predominant influenza strain was A (H3N2), representing 73.8% of all circulating influenza. Pie chart displays this information. Graph showing the numbers and percentages of respiratory specimens positive for influenza viruses, and numbers of influenza viruses identified, by type, by surveillance week, Department of Defense healthcare beneficiaries, 2016 – 2017 influenza season displays. The vaccine effectiveness (VE) for this season was slightly lower than for the 2015 – 2016 season, which had a 63% (95% confidence interval: 53% - 71%) adjusted VE. The adjusted VE for the 2016 – 2017 season was 48% protective against all types of influenza.  Access the full report in the January 2018 MSMR (Vol. 25, No. 1). Go to: www.Health.mil/MSMR

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2018 #ColdReadiness Twitter chat recap: Preventing cold weather injuries for service members and their families

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To help protect U.S. armed forces, the Armed Forces Health Surveillance Branch (AFHSB) hosted a live #ColdReadiness Twitter chat on Wednesday, January 24th, 12-1:30 pm EST to discuss what service members and their families need to know about winter safety and preventing cold weather injuries as the temperatures drop. This fact sheet documents highlights from the Twitter chat.

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Coverage with most recommended vaccines remained stable and high in 2016. Disparities in vaccine coverage in children were found by race, poverty status and insurance status.

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Did you know  … ? In 2016, essential hypertension accounted for 52,586 encounters for health care among 29,612 active component service members in the U.S. Armed Forces. Of all cardiovascular diseases, essential hypertension is by far the most common specific condition diagnosed among active duty service members. Untreated hypertension increases the risks of subsequent ischemic heart disease (heart attack), cerebrovascular disease (stroke), and kidney failure. CHART: Healthcare burdens attributable to cardiovascular diseases, active component, U.S. Armed Forces, 2016 Major condition: •	For all other cardiovascular the number of medical encounters was 70,781, Rank 29, number of individuals affected was 35,794 with a rank of 30. The number of bed days was 4,285 with a rank of 21. •	For essential hypertension the number of medical encounters was 52,586, rank 35, number of individuals affected was 29,612 with a rank of 35. The number of bed days was 151 with a rank of 86. •	For cerebrovascular disease the number of medical encounters was 7,772, rank 79, number of individuals affected was 1,708, with a rank of 96. The number of bed days was 2,107 with a rank of 32. •	For ischemic heart disease the number of medical encounters was 6,629, rank 83, number of individuals affected 2,399 with a rank of 87. The number of bed days was 1,140 with a rank of 42. •	For inflammatory the number of medical encounters was 2,221, rank 106, number of individuals affected 1,302 with a rank of 97. The number of bed days was 297 with a rank of 72. •	For rheumatic heart disease the number of medical encounters was 319, rank 125, number of individuals affected 261, with a rank of 121. The number of bed days was 2 with a rank of 133. Learn more about healthcare burdens attributable to various diseases and injuries by visiting Health.mil/MSMRArchives. #LoveYourHeart Infogaphic graphic features transparent graphic of a man’s heart illuminated within his chest.

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