Vaccines in 2013

Happy almost-2013! In honor of the New Year, I thought I would share a couple of the news items I will be watching for in 2013.

First, as always, is flu. This year's flu season has supposedly been off to a very early start, but by my accounting of the total number of infections on the CDC's national influenza summary, through week 51, there have only been 15,106 infections this year. I know--there have also been 16 pediatric deaths, which is absolutely terrible, and if you are one of those 15,000-some who is infected, you're probably in significant discomfort at best and some pretty serious trouble at the worst. And I also know that the number of reported cases represents only a fraction of the number of actual infections. But, still, 15,000 infections doesn't sound like a lot, in a nation of 300 million--to me, anyway. Everyone is going to have a different reaction to that information.

Vaccination rates are about the same as they were last year. I'm sitting in a room of five adults right now, and none of us got our flu vaccine; two say they intend to, but it hasn't been convenient so far. So, I guess we're contributing to the problem. Next year, there will be two quadrivalent flu vaccines: MedImmune's Flumist Quadrivalent and the newly approved Fluarix, an intramuscular vaccine produced by GlaxoSmithKline. Both of these vaccines will protect against the two most common Influenza A-type and Influenza B-type viruses. The addition of a second Influenza B virus may result in fewer infections.

But, as the CDC's website reminded me today:

The seasonal flu vaccine does not protect against influenza C viruses. In addition, flu vaccines will NOT protect against infection and illness caused by other viruses that can also cause influenza-like symptoms. There are many other non flu viruses that can result in influenza-like illness (ILI) that spread during the flu season.

I mean, I knew that, but it doesn't exactly get me excited for a flu vaccine, since it just reminds me of all of the things that can still make me sick no matter what I do. Yippee.

Anyway, next year, I will be looking out to see how these quadrivalent vaccines are marketed, if the uptake rates are higher, if more adults in particular (like those sitting with me in the room right now...) are motivated to be vaccinated, and so on.

Second, I'm also going to continue to watch news of the pertussis outbreaks. I'll be watching to see how/if the epidemic continues, how rates of infection pan out (adults? children? infants? college students?), and how serious is this going to get. Mostly, I'm curious to see how the story gets told: is this going to continue to be evidence of the "evil" of vaccine skeptics, who demanded the (now less-effective) acellular vaccine despite relatively unsubstantiated evidence that the whole-cell DTP vaccine caused neurological side effects? And damaged herd immunity by refusing the TDaP vaccine? Or, will those who remain skeptical use this as evidence of long-term ineffectiveness of vaccinations as a practical public health solution? Both arguments are out there. I'll be interested who uses what argument and when.

Back to dissertating. Happy New Year. Get a flu shot. Or wash your hands a lot. Or both. Or just accept sickness as an inevitability of life. Welcome, 2013!

On the Vaccine-preventable Disease Outbreak Narrative

Articles like this one that appeared in Parade a few weeks ago, "Why so Many Parents Are Delaying or Skipping Vaccines,"not only hit my radar because I follow its author, Seth Mnookin, on Twitter and he tweets like 7 times an hour. Not that I'm complaining--I feel certain at most times that I know everything going on in vaccination just by following him.

I continue to be surprised and intrigued by the number of articles that appear--in the popular media as well as scientific journals--that claim to have answers to vaccine controversy. Yet, not only do these articles rarely provide any actionable answers (other than encouraging people to vaccinate), but they also tend to report mostly by re-hashing a standard narrative about vaccine refusal, complete with cast of good guys and bad guys and what happens when even a few parents refuse to vaccinate:

Bad guys:

• Andrew Wakefield (whose 1998 argument that MMR vaccination caused rising rates of autism is characterized as the impetus for today's vaccine controversy) 
• Vaccine success (diseases now seem so rare that parents aren't afraid of them and skip vaccinations)
• Parents in affluent, well-educated areas who are overly concerned with environmental issues and child development (so, focused on the wrong things, they refuse vaccines to avoid environmental contaminants and instead put their kids--and others--at risk for disease; they also worry about autism and think it is related to vaccines, thanks to Andrew Wakefield [above])

Good guys: 

• Vaccines (of course. They have greatly reduced measles and polio worldwide and have eradicated small pox)
• Herd immunity (which protects everyone--vaccinated and unvaccinated--from contagious disease)
• Health officials, researchers, and doctors (who, try and try as they might, cannot out-persuade Jenny McCarthy)

Narrative:

Parents stop fearing diseases because they have become rare. A segment of parents fears vaccines instead because their resources afford them the time and education to over-research vaccine safety and indulge their personal political whims. Parents delay vaccines. Disease comes to a community, circulates to unvaccinated children, but then vaccinated and immune-compromised children become sick as well. Doctors don't recognize the diseases the children present with because they are so uncommon now. Children die or become very ill. Non-vaccinating parents learn that diseases are serious and that they should vaccinate. Vaccinating parents learn that parents who don't vaccinate their children don't realize that their decisions put others at risk.

I don't disagree with this narrative so much as I am perplexed by its over use. Paul Offit's Deadly Choices begins with a similar story, and Mnookin's book is peppered with similar stories throughout. And even when the full narrative isn't present, the good guys and bad guys are almost always the same. 

What is it about this set-up that is so compelling as a story for why vaccines are necessary? 

After all, the case of the pertussis outbreak in Floyd County, Virginia, which Mnookin mentions off-hand but doesn't delve into here (but does here), offers an excellent example of a vaccine-preventable disease outbreak that didn't happen that way. 

Floyd County is not an incredibly affluent area, and the people in that community clustered at a local, private "alternative" school largely shared values that made them avoid vaccination, so this was not an isolated segment of this community that avoided vaccination--the community was essentially made up of non-vaccinators. The disease ended up spreading to about 30 people and engaged a nearly immediate response from the health department, so there was no widespread confusion about what disease people had, causing surprised doctors and delayed diagnosis. Finally, all of those who contracted pertussis were unvaccinated, so the vaccinated child with a rare disorder that made her susceptible to disease was not present. And there were no fatalities. 

Other than perhaps the ideologies behind not vaccinating (it is unclear if environmental or backlash against the government or something else is why those parents did not vaccinate), this story differs at every turn from the story Mnookin relates here, which has a predictable, convenient narrative arc that has to end with an unvaccinated child getting sick. Not to say that that isn't a serious ramification of vaccine refusal or that it is necessarily incorrect much of the time.

But just as the case of Floyd County demonstrates, it isn't the case all of the time, making it possible that the telling and re-telling of this narrative is serving some other purpose, to reify the dangers of non-vaccination among vaccinating and non-vaccinating parents alike, creating a possible counter-narrative to vaccine safety arguments. After all, the vaccine choice that vaccine skeptics advocate isn't really possible in an environment where everyone is truly at risk, demonstrating the larger rhetorical purpose for the telling and re-telling of this narrative.

 

The Hazy World of Vaccine Messaging

After almost 3 years now of complete absorption into issues related to vaccination, it's no surprise that I continue to be fascinated and dumbfounded by the complexity of the rhetorical situation that occurs when a doctor must convince a new parent (or even an old one) that vaccines are the right course of action for protecting a child. The issue has been researched and studied and battled for hundreds of years, and as much as vaccines may be an "answer" to the scourge of small pox, polio, and measles, no "answer" has yet emerged that guarantees that vaccines will be accepted by the people they are intended to protect. I'm fascinated and in some ways encouraged that, in this case, a scientific discovery comes along quicker than a rhetorical one.

On Twitter (my new, sole connection to the outside world since I started writing my dissertation) today another piece of yet more confusing information about vaccine messaging rolled across my feed. This article in Scientific American reports on a study published in Health Psychology about the role that pro-vaccine messages play in convincing parents of vaccine efficacy and safety. 

The article states, in what seems like a completely counter-intuitive conclusion, that after participants were told to "imagine parenting an 8-month-old" (maybe a problematic scenario; I'd have to read the study to understand this, but couldn't they just have gotten participants who actually were parents of 8-month-olds?) and were told about a serious disease that the doctor wanted the parent to vaccinate against: "Those who were told there was no evidence for risk [from the vaccine] reported greater concern about vaccination and less intention to vaccinate their child than those who read the moderate messaging. The effect intensified when the messaging came from a perceived untrustworthy source, like a pharma company."

The conclusion the article draws is that a harder sell for the vaccine might produce the opposite effect, and so therefore a softer sell may be more effective. 

I have two thoughts: first, I have a lot of questions about the population/participants here, and I really wish I had time to find this study and give it a closer look. To imagine you're the parent of a baby, and then to imagine being told about a disease, and then to imagine how you might react to different ways of "selling" the vaccine constitutes a lot of imaginative leaps. I don't want to extrapolate too much on that without reading the full study, but I am really curious why they didn't ask actual parents of 8-month-olds. I also wonder whether they had a doctor, pediatrician, or a researcher present this scenario. Here, I'm thinking ethos: did the person seem concerned, did the person seem like an advocate for children, or did he/she seem disinterested? That could have played a role in how the "parent" interacted with the person delivering the information relative to disease perception and need for vaccination. 

Second, I don't think this is about hard/soft sells. I think the believability, in this case, has to be tied to trust in some way. Does anyone really think that any medical treatment comes with absolutely no risk? We are so engrossed in a culture and scientific reality now that knows about and accepts side effects as an expected part of any treatment, that it would strike me as suspect if someone told me that there were no risks rather than just some risks. 

In my Literature, Medicine, and Culture class a few weeks ago, we looked at commercials for Ambien, one from 2000 or 2001 and another from 2012. The list of side effects in the 2012 commercial takes up more airtime than the actual description of what the drug is supposed to help, and the list ranges from mild side-effects to ridiculous things (that have by now been well-publicized) like hallucinations and sleep walking. 

This expectation of risk may not stop us from being surprised or annoyed when we take a medication and it makes us sick in ways we weren't anticipating, but at the outset, I think I would feel lied to if a doctor told me there was absolutely no risk as a result from treatment, and that is particularly true with parents and vaccines. Even people who are pro-vaccine know that there are risks associated with the vaccination, even though they are rare when severe. 

So, again, I don't think this has to do with the "hardness" or "softness" of the information as presented. My sense is that it has more to do with believability, trust, and the logos at work here. If the participant feels liked to or deceived by being told that the vaccine carries no risks, then that person may be less likely to trust the related recommendation. But, if the speaker acknowledges the side effects and risks, then the appeal matches the expectation of risk, and the person feels leveled with, spoken to honestly. 

The inherent persuasiveness trust, even if risks are involved, may be more convincing than the imaginary notion of a risk-free world, or even a risk-free treatment.

Placebo/Nocebo/Bad(?) Science

Just a quick post today. Article to finish. Classes to plan. Dissertation to write.

Somehow through the snarl of articles and news and live-tweeting of random events that is Twitter, I've encountered two intersecting items of interest lately that I think warrant further discussion.

The first is this, a Ted Talk that I had somehow never heard of, by Ben Goldacre. Not only is Goldacre great to listen to (as are all Ted Talks, right? You're laughing, you're learning, it's all great fun), but he makes an excellent point about the fuzziness of science, particularly pharmaceuticals. I don't know that I actually realized before that pharmaceutical companies conduct trials not against existing treatments but against placebo. I agree with him--that doesn't seem right. If you're proposing an alternative drug, shouldn't you measure its effectiveness against the current recommendation? Even more problematic and ethically fuzzy is the idea that companies can skew the effectiveness and preferences for the drug by administering existing medications at the higher end of the recommended dosages, artificially increasing the incidents of side effects and adverse outcomes.

Goldacre ends on an interesting point, which reminded me of an article my friend Virginia sent me about a month ago on the "nocebo effect." We all know about the placebo effect--I take a sugar pill in a clinical trial, I feel better because my brain tells my body that it might be getting medicine that makes it feel better. It's an amazing phenomenon that, I agree with Goldacre, we almost take for granted. It is amazing how much the simple availability of medication skews our interpretations of our bodies so much. But lesser known is the nocebo effect, where people experience false side effects from sugar pills. So, the operation is the same but the outcome is different--I take a sugar pill in a clinical trial, and I feel worse because I think I'm experiencing the side effects of the medication.

I can't say much more than summary and awe for right now, but I do think the placebo/nocebo effects are worth some more study, and by rhetoricians in particular. The NYT article about the nocebo effect shows--as have many studies in rhetoric on the discourses of patients and doctors--that the ways that side effects are described situate the expectations of the patient in certain ways. If pain is downplayed, patients feel less pain; if it's emphasized, patients feel more. Certainly the rhetorics we're given, in clinical trials and in popular media, about the benefits and drawbacks of medications are affecting our own perceptions of health and pain as well as how medicine figures into maintaining or avoiding symptoms.

Micro-post: On Crutch Words

I came across (okay, Twitter alerted me to the presence of) this article, "Actually, Literally, What Your Crutch Word Says About You" in The Atlantic tonight, and I was both astonished and disappointed in myself that I use almost all of the major catch phrases on this list.

My biggest offenders:

Actually ("Literally," only with attitude, which is true to how I mean it, so fair enough.)
Basically (I had to edit "basically" out of my previous parenthetical and instead say "true to.")
At the end of the day (Just another version of "basically," right? As in, "cutting to the chase." Whatever. I like it)
For what it's worth (More emphasizing, summarizing. I guess I have a problem with this?)
Seriously and Honestly (To be fair [another one of my crutch phrases], I say "seriously" more on its own. Like, "Seriously? He seriously said that?" Which feels different than the example given. And I always mean "honesty" with sincerity.)
Apparently (You got me there. Use it all the time, probably unnecessarily.)
Like/um (everyone uses those. Get over yourselves, The Atlantic.)

So, the only one I don't really use is "literally," which I guess is a good thing, because at least that makes me more linguistically adept than Joe Biden. Though, for what it's worth, that still isn't actually saying much, at the end of the day. Honestly, and apparently.

Mini-Hiatus: Back to School

Well, it's back-to-school time here at Tech, which means prepping for two new classes for me. This semester will be my first semester back to teaching my own class since spring 2009, and the first time in an undergraduate classroom since Spring 2011, when I was the TA for Grant Writing. It's exciting mostly. I'm teaching two courses: Literature, Medicine, and Culture and Technical Writing. Two totally different classes. Two totally different groups of students. Two totally different preps.

Oh, and I'm writing a dissertation and finishing an article. It's a busy time.

Anyhow, blog posts will probably be short and delayed in coming days/weeks, but I am trying to stay current with Twitter, so please follow me there @hylawrence for my updates and thoughts on vaccines, health, and medicine, particularly H3N2v, which I'm currently fascinated by and terrified of.

And speaking of fear and disease, no one really does it better than Jezebel:

http://jezebel.com/5938583/were-all-gonna-die-the-infectious-pandemics-of-summer-2012

and

http://jezebel.com/5932189/oh-great-swine-flu-is-back

Zombies

Okay, so I intended to write this blog post about the newest information circulating on the H3N2v flu that has picked up significantly this summer. Because that seems pretty important and scary as we approach flu season.

But instead, I find myself compelled to write about Zombies.

Almost two years ago now, a group of undergraduate students in the VRG conducted a survey about flu and flu vaccine practices among undergraduates. The survey consisted of multiple choice as well as fill-in-the-blank questions that elicited narrative responses, allowing the students to do both quantitative and qualitative analyses on the results (the resulting poster can be found on the VRG website here).

One of their observations from the narrative responses was about Zombies. A couple of the narrative responses in the survey said something about vaccines turning people into Zombies, which they then connected to the movie I am Legend, where (if I recall correctly) a cancer vaccine turns people into Aombies. Or something like that. At the time I remember us all initially thinking that the respondents, while clearly trying to just be funny or mess around with the survey, had really hit on a connection that was surprising--that there were other fictional connections between diseases, viruses, and vaccines and Zombies.

So, imagine my surprise when I was looking for information on the CDC's website the other day on H3N2v and saw a blog category called "Zombies" alongside other completely serious categories like "Anthrax" and "Zoonotic Disease."

http://blogs.cdc.gov/publichealthmatters/category/zombies/

Apparently they have used a Zombie attack as a preparedness scenario, with the recommendation that people "Make a Plan. Get a Kit. Be Prepared." for a Zombie attack, which is the same recommendation FEMA has for any kind of preparedness. Here are just a few of the links on the CDC and Zombies:

http://www.cdc.gov/phpr/zombies.htm

http://www.bt.cdc.gov/socialmedia/zombies.asp

http://www.cdcfoundation.org/zombies

And, in case you have ever thought, "Wow, I wish that the CDC would write a novella about the possibility of a Zombie attack and what I might do to be prepared for it," you will be happy to learn that there IS a Zombie novella written by the CDC about the possibility of a Zombie attack and what you might do to be prepared for it: http://www.cdc.gov/phpr/zombies_novella.htm

So, I thought all of this was kind of strange, but I know that some people are kind of fascinated with Zombies and like to talk about them a lot and watch movies about them and things like that, so I thought it was maybe just some strange person's sense of humor driving this odd basis for a preparedness scenario.

But, apparently this was a big thing earlier this summer (which I somehow missed). Of course, Colbert has the best coverage of the story:

http://www.colbertnation.com/the-colbert-report-videos/414850/june-05-2012/cdc-zombie-apocalypse-statement

But it also got coverage from some other news outlets:

http://abclocal.go.com/wls/story?section=news/bizarre&id=8140256
http://rt.com/usa/news/cdc-denies-zombie-apocalypse-855/
http://www.huffingtonpost.com/2012/06/01/cdc-denies-zombies-existence_n_1562141.html

I guess a rash of crimes that involved cannibalism somehow awakened fear of Zombie-like behavior, which then somehow got connected to the "tongue-in-cheek" Zombie scenarios created by the CDC, which then necessitated a STATEMENT by the CDC that it “does not know of a virus or condition that would reanimate the dead (or one that would present zombie-like symptoms)” (quotation from RT article).

I don't know what I have to say about all of that just yet, but I end on the following reflection:

In a presentation I did for the Association for Business Communication (ABC) three years ago, I analyzed FEMA's "World Upside Down" PSA, which uses the metaphor of a world "turned upside down" as the impetus for encouraging families to be prepared for disaster.

In that analysis, I argued that the nonspecific nature of the outcome of that metaphorical emergency was rhetorically problematic--that it kept the idea of disaster preparedness in a fictional realm whereby people could not imagine that they would be victims of a major disaster or what the consequences of that disaster might be. Without relaying some kind of situated exigence for disaster preparedness (like, do you know what would happen to your pet if you had to evacuate your home in an emergency? or do you have the materials to shelter-in-place? or how would you reunite with your family after an emergency during a work day?), the PSA relays a general message that something bad could happen at any time, and it might be a good idea to have supplies around in case that happens. Most people know that already, I argued.

But, was I wrong? The Zombie scenario seems to do another version of the same thing, although I admit it's much catchier. You see the widget or poster or t-shirt with "Prepare for the Zombie Apocalypse" on it, and it least it catches your eye. Makes you say "what?" Creates an impression, a curiosity that the "world upside down" doesn't. But, in the end, does it produce the same, imagistic, metaphorical, but ultimately unrelatable effect? Does it venture too far into the ridiculous to be taken seriously? I'd be curious to ask them what kinds of responses they have gotten to these campaigns. I wonder if maybe my assessment is too harsh--that maybe it is better to create a nonspecific notion of preparedness in peoples' minds so that they can apply the need to prepare to whatever they think is most pressing or most applicable to their situation.

This has to be a question across any kind of preparedness issue, whether it is disaster preparedness or public health. It also asks a basic question of the Health Belief Model: what motivates people to take the officially-sanctioned actions to protect themselves? In rhetoric, we might ask, what combination of ethos, pathos, and logos will persuade the public to believe official recommendations and be motivated to take action? Will a believable spokesperson help? A fear tactic? Data on disaster likelihood and related necessities? With both "world upside down" and Zombies, we've abandoned the world of logos and possibly ethos and are left with pathos--either the impetus to be afraid of or laugh at the scenario presented that rouses the audience to attentiveness. And it might do that. But does it promote action? A genuine question, for me at least.

Gardasil: Gender, Science, and Public Rhetoric

There's a lot to say about Gardasil controversy. It brings up many of our favorite problem subjects that invite polemic from all sides--sexuality and sex practices, sexual behavior of girls, women's health, efficacy of vaccines, rights to refuse vaccines, et cetera.

This "Comment" piece I read today in The Guardian, "To deny schoolgirls a cervical cancer jab on religious grounds is scandalous" (quick side note, I absolutely LOVE the difference between calling a vaccine a "jab" instead of a "shot") brought the issues of gender as well as scientific versus public rhetoric to light in what I thought were some very interesting ways.

Gardasil vaccine controversy has some significant differences from your garden-variety MMR vaccine refusal or flu vaccine skepticism for one major obvious reason: until recently, the vaccine was chiefly marketed as the "anti-cervical cancer" vaccine, and hence was only advertised (and FDA-approved) for girls and young women.

Yet, HPV infection causes more than cervical cancer and affects more than women--HPV is the cause of genital warts in both men and women, is more common among men than women, and causes throat and anal cancers in both sexes. (See this and this and this for some NYT coverage of new research about the prevalence and consequences of HPV infection in both sexes as well as this research published in the Journal of Clinical Oncology on HPV infection and throat cancers.) Now it is recommended for both boys and girls as young as 9. The vaccine is still only recommended until age 26.

Doctors were only ever interested in Gardasil as cancer prevention, not as one against genital warts or other non-sex-specific problems that arise from HPV infection, so the product was always intended for women and girls. Possible uses for boys and men emerged later.

This, to me, is an interesting space where scientific and public rhetorics clash.

On the one side, you can see the trajectory of thinking in the scientist's brain here: Isn't it amazing that a virus causes cancer? We can vaccinate against viruses. Wouldn't it be amazing if we could vaccinate against that virus, hence eliminating cancer? What kinds of that virus cause the most cancer, giving us the biggest bang for the buck? Oh, 4 virus types cause 70% of cancer in the cervix. Let's vaccinate against those. Only women have cervixes. Let's only do clinical trials on them. Wow, the vaccine works! And it's approved! Yay, science! (Or something like that.) In this sense, this is truly groundbreaking stuff with incredible implications for the future of virology and cancer research.

Yet this incredible discovery looks very different in the (bright, unforgiving) light of public opinion. The message goes from being "this vaccine can prevent cancer" to "you should vaccinate your daughter against this sexually transmitted disease." Uh oh. That will (and did) revive every argument ever created about sexual behavior and gender-based expectations.

Not only did that result in an initial negative reaction among parents (along the lines of "my daughter will never have sex outside of marriage, so she doesn't need to worry about this") but gender continues to be central in public debates about the safety, efficacy, and availability of Gardasil.

I'm not going to even try to capture all of the arguments how unsafe Gardasil is. Just Google "Gardasil Injury" and you'll see hundreds of websites, videos, blogs, organizations, support groups, etc. that have all amassed to argue that injuries from Gardasil vaccination span a range of problems, from acute, severe reactions to long-term chronic illnesses that have destroyed healthy girls and vibrant families. Women are, in these narratives, innocent victims of a scientific community that demanded compliance, injured countless women, and remains insensitive to their pain.

Those who support the vaccination also use gender to argue for increased availability of the vaccine; as the article in The Guardian demonstrates, advocacy for the vaccination is seen as protection of women's health, and lack of access to the vaccine is seen as further intrusion of the state into the health issues of women, echoing public debates we have about abortion and contraception. By both sides of the debate, girlhood and womanhood are used to create claims of coercion and victimization by entities that either demand that they do or do not get the vaccine.

For all of these reasons, and many more, Gardasil functions as a fantastic example of how science and the public clash over vaccinations when scientific discoveries become divorced from the realities of their public purpose. I wonder how the (continuing) lessons of Gardasil will (or will not) impact the next new vaccine and the sex-based distinctions researchers make as their products are developed, tested, and marketed for targeted populations.

The Vaccination Research Group at Virginia Tech

http://www.vaccination.english.vt.edu/

The Vaccination Research Group (VRG) at Virginia Tech is a collaborative research group that brings together faculty and students from a variety of disciplines, including English, Public Health, History, and Computer Science.

Together, we conduct research projects into historical and contemporary vaccine controversy with the aim of increasing understanding of vaccine skepticism and achieving improved communications among doctors, patients, health officials, and communities nationwide.

The group encourages undergraduate research by involving undergraduate researchers who conduct their own original research in support of faculty projects; student members create reports and other deliverables for publication on our website.

Graduate students (like myself) have also supported the group by bringing their dissertation or other research projects to the group for assistance, support, and feedback. I've been fortunate enough to be involved in the group since it began, and it has richly inspired and informed my graduate and professional work.

If you're interested in issues related to vaccination, please check out our website; send questions to vaccine@vt.edu.

Pertussis...

The pertussis outbreaks in Floyd County last year didn't quite make national (or even regional) headlines, but it appears that the depth and breath of this year's outbreaks of pertussis are gaining a lot of press (and specific coverage in last week's MMWR, which only focuses on Washington state, where the Secretary of Health declared a pertussis epidemic in April).

Outbreaks are happening nationwide and internationally, as The Guardian reported today that 5 infants have died from pertussis so far this year. Lots more to look into there, particularly as it relates to the Olympics and travel to/from London.

Interesting trends that I'm seeing, both in the actual outbreaks and the reporting:

1. Lots of emphasis on getting vaccinated as a way to control these outbreaks and to lessen the intensity of symptoms if one does contract pertussis. 
2. This article in the LA Times gives, I think, an interesting explanation for why so many teens and adults have waning immunity: the change to acellular DTaP vaccinations in the late 1990's. 
3. The article describes the change from DTP to DTaP as a response to concerns about side effects, namely rare, "inconsistently" proven neurological side effects (like those first brought up in DPT (sic): Vaccine Roulette, I believe).  It will be interesting to see how those claims continue to develop as a part of popular and government reporting on the outbreaks.
4. Most of the articles I'm seeing don't use that rationale for blaming antivaccinators for these outbreaks and focus instead on the risk that low vaccination rates pose to herd immunity. This article in Forbes is particularly harsh.

A Vaccine for AIDS?

"Scientists Hunting for an AIDS Vaccine May be Getting Close," The Washington Post, Alyssa Bothello, July 23, 2012

http://www.washingtonpost.com/national/health-science/scientists-hunting-for-an-aids-vaccine-may-be-getting-close/2012/07/23/gJQA9TJt4W_story.html

The idea of a vaccine for AIDS is powerful in the context of vaccine controversy.

Vaccines against diseases perceived to be sexually transmitted have historically been controversial.  Elena Conis's brilliant 2011 article in the Journal of the Medical Humanities, "'Do We Really Need Hepatitis B on the Second Day of Life?' Vaccination Mandates and Shifting Representations of Hepatitis B" offers an extensive--and remarkable--history of hepatitis B vaccination regulations in the United States. But, even without access to JSTOR, you only need to read a few articles on controversies around Gardasil to know that, as much as it was marketed as a vaccine against cervical cancer, nearly all of the chatter that arose following its deployment related to its protection against HPV infection, which is of usually sexually transmitted. The argument that these vaccines should not be required because the diseases they prevent are avoidable and not communicable in a public setting has some validity (and is the basis for the Gardasil exemption in Virginia).

Yet at the same time, I don't know that, in the popular sense anyway, cervical cancer or hepatitis B are quite the same as AIDS. There isn't the same fear attached, the same seeming ubiquitousness, the same mystery of the virus to end all viruses. The same death toll, expenses, or community action. I grew up in the 1980's, so the full impact of AIDS was a bit before my time. Yet, even I have distinct memories of AIDS in ways that I don't have about other diseases--Ryan White, the child with AIDS; Pedro on The Real World; the loss of my uncle to HIV/AIDS in 2008. I imagine everyone has some combination of the personal and media experiences with AIDS that aren't quite the same as those we might have about cervical cancer or hepatitis.

So, what will the public reaction be to the AIDS vaccine in the United States, if it ever gets here? Will people clamber for it? Refuse and protest in droves? React with apathy? Rejoice? Will it make a difference? How will AIDS change culturally as a disease? Will it become like polio or rubella--something you get vaccinated for that you wouldn't even know you had if you came down with it?

Either way, in addition to having a potentially powerful effect on global health, the social implications of such a vaccine will be considerable, and fascinating to watch.