random vaccine and VPD related questions, post your own and answer if you know!

[nukuspot]

I like to research.  A lot.  But I still have a few vaccine and VPD related questions that I can't seem to find a satisfactory answer to.  I know that many of us on here have different backgrounds in research, health care, etc, and I wanted to post my queries to see if anyone knows the answer to them.  Likewise, I'd like this thread to serve for others as a place to ask their random vaccine/VPD questions to others.

Vaxxers and non vaxxers alike please weigh in if you can.  Just PLEASE keep it polite and civil and also PLEASE PLEASE refrain from any personal diatribes/conspiracy theories here.  It is OK to post a hypothesis of why you think something might be....Just make sure it is at least based on some sort of factual research.

OK, MY questions off the top of my head are:

-Why do most CDC/department of health publications say that tetanus can be found "anywhere, even house dust" when it is proven that the spores cannot live in oxygen.  An aerobic environment like house dust is fully exposed to oxygen, right?

-Why is the dose for diptheria in the DT or DTaP so much higher for children 0-7 than 7-adult?  What research is there that shows that a (for example)  10 lb baby needs 7 times the dose of diptheria toxin to develop immunity than a 200 lb adult?  (This also goes for pertussis, comparing the amount in the DTaP to the Tdap.)

-Why is pertussis still bundled in to the 3 part DTaP or Tdap when a full series of Tetanus and Diptheria is 3 doses followed by boosters every 10 years, and pertussis is 4 (or 5, depending on age) doses with a booster needed much more frequently?  (Studies coming out say pertussis boosters might be needed every 3-5 years to maintain immunity from the primary series.)  I understand why D and T would be bundled since they are on the same schedule, but why pertussis?  So much extra D and T is given by combining all 3.

-Why were the strains of strep pneumonia that are in Prevnar chosen?  Are they the most common strains, the most dangerous, or the ones that were more concerning at the time?  Does it make sense to periodically reformulate Prevnar to reflect the current strains out there like is done with the flu vaccine?

-Are there any books out there that exist to give a factual history of the development of vaccines that are not biased either pro or anti vaccine?  I have never found one myself that does not reflect the author's bias.

I have more, but let's start with these.  Hope people might be able to help me answer them!

[slmommy]

good questions. 

about the amount of pertussis antigen in DTaP vs. Tdap, this is what I have seen:

Quote:

Pertussis is common in teenagers and adults. Therefore, a vaccine to prevent pertussis in teenagers and adults is of great benefit. However, the "old" whole-cell pertussis vaccine and the "acellular" pertussis vaccine for young children (DTaP) had a high rate of side effects when given to people older than 7 years of age

...

The Tdap vaccine is different from the DTaP vaccine because it contains lesser quantities of diphtheria and pertussis proteins. For this reason, Tdap is much less likely than DTaP to cause side effects such as pain, redness and tenderness in adolescents.

 

http://www.chop.edu/service/vaccine-education-center/a-look-at-each-vaccine/dtap-diphtheria-tetanus-and-pertussis-vaccine.html

My jaded self would say that probably this is just because older children can communicate their side effects more and has nothing to do with older children/teens/adults actually experiencing more side effects, but that is why there is less antigen.

Why P is never alone? My biased self would say it is probably more convenient/financial interesting to produce all together, just like MMR... and no one actually cares that people are getting "extras" ... if you don't acknowledge or believe vax ingredients are harmful in their quantities, then why would you mind "extras"? I think the only reason DT and T are available is because of the numerous and serious reactions people had to the old P especially.

From what I've read, combo vaccines are always touted for improving compliance and convenience. 

[purslaine]

Do you think the pneumonia vaccine would be effective against pneumonia that results as a secondary infection (specifically - after the flu) ?

[purslaine]

.

[pers]

Originally Posted by nukuspot 

-Why do most CDC/department of health publications say that tetanus can be found "anywhere, even house dust" when it is proven that the spores cannot live in oxygen.  An aerobic environment like house dust is fully exposed to oxygen, right?

Tetanus bacteria can not survive in oxygen.  Tetanus endospores, on the other hand, can survive pretty much anything, including oxygen exposure.  

[katelove]

Originally Posted by nukuspot 


-Why were the strains of strep pneumonia that are in Prevnar chosen?  Are they the most common strains, the most dangerous, or the ones that were more concerning at the time?  Does it make sense to periodically reformulate Prevnar to reflect the current strains out there like is done with the flu vaccine?

Yes, they are the ones most commonly seen. Prevent is updated periodically, although not as often and not in the same way as the flu vax. Prevenar13 recently replaced prevenar7.

I think the reason strains are not removed and replaced as with the flu vax is that the pneumonias are more stable and don't mutate into entirely new strains as often as the flu. The same ones will still be around.

[katelove]

Originally Posted by kathymuggle 

Do you think the pneumonia vaccine would be effective against pneumonia that results as a secondary infection (specifically - after the flu) ?

Theoretically, if the secondary pneumonia was caused by one of the strains it included.

[purslaine]

Originally Posted by katelove 


Theoretically, if the secondary pneumonia was caused by one of the strains it included.

How would I figure it out?  

Edited by purslaine - 6/9/12 at 5:04pm

[katelove]

Originally Posted by kathymuggle 

Originally Posted by katelove 

Theoretically, if the secondary pneumonia was caused by one of the strains it included.

How would I figure it out?  

Work out what strain you had? Sputum culture usually.

[purslaine]

Originally Posted by katelove 


Work out what strain you had? Sputum culture usually.

Hmmmm……I am not that interested in knowing what strain she (DD) had - I am more interested in avoiding pneumonia in the future.  Is the strain of pneumonia brought on by flu commonly found in the pneumonia vax?  

[Rrrrrachel]

The flu is a common cause of the type of pneumonia in the vaccine. There are actually several vaccines that help prevent pneumonia.

http://www.cdc.gov/Features/Pneumonia/

[nukuspot]

Originally Posted by pers 

Tetanus bacteria can not survive in oxygen.  Tetanus endospores, on the other hand, can survive pretty much anything, including oxygen exposure.  

http://suite101.com/article/bacterial-pathogens-of-the-genus-clostridium-a218484

Thanks! One question answered.

[nukuspot]

Originally Posted by slmommy 

good questions. 

about the amount of pertussis antigen in DTaP vs. Tdap, this is what I have seen:


My jaded self would say that probably this is just because older children can communicate their side effects more and has nothing to do with older children/teens/adults actually experiencing more side effects, but that is why there is less antigen.

Why P is never alone? My biased self would say it is probably more convenient/financial interesting to produce all together, just like MMR... and no one actually cares that people are getting "extras" ... if you don't acknowledge or believe vax ingredients are harmful in their quantities, then why would you mind "extras"? I think the only reason DT and T are available is because of the numerous and serious reactions people had to the old P especially.
From what I've read, combo vaccines are always touted for improving compliance and convenience. 

That's what I can find too. But why? Why SEVEN times as much pertussis toxin in the 0-7 version? There has to be a reason. There just has to! Otherwise it's too random.

[nukuspot]

Oh also....Why does Daptacel have half the amount of pertussis than Tripedis did or Infantrix does....Yet they are all used interchangeably?

[slmommy]

Originally Posted by nukuspot 

Oh also....Why does Daptacel have half the amount of pertussis than Tripedis did or Infantrix does....Yet they are all used interchangeably?

yeah... and add to that, when "daptacel" is the dtap in Pentacel, it DOES have more antigens than regular daptacel. 

Quote:

While Pentacel and DAPTACEL (Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed [DTaP], Sanofi Pasteur Limited) vaccines contain

the same pertussis antigens, manufactured by the same process, Pentacel vaccine contains twice the amount of detoxified pertussis toxin (PT) and four times the

amount of filamentous hemagglutinin (FHA) as DAPTACEL vaccine.

https://www.vaccineshoppe.com/image.cfm?doc_id=11169&image_type=product_pdf

Sanofi Pasteur states that Pentacel has better pertussis seroprotection rates and geometric mean antibody concentrations than Daptacel... well, for pt, fha, and fim, pertactin goes better for Daptacel...

http://www.pentacel.com/effective.html

I don't know where you can find these answers... maybe try calling the manufacturers? I can't really think of anything else... and it would be interesting to see what response you would get.

[slmommy]

oh, rrrrachel posted IOM's Adverse Effects of Vaccines a few weeks ago, and there is some interesting info there... maybe a little bit of the historic "unbiased" info you are looking for, not that in depth, but some factual info about the development. (at the start of every vax chapter they give some basic facts about when first developed, by who, reformulations, etc.)

http://books.nap.edu/openbook.php?record_id=13164&page=525

Also they have a great table here of the different DT, DTaP, tdap, etc. vaccines/brands and their varying concentrations of antigens: (pages 531-33)

http://books.nap.edu/openbook.php?record_id=13164&page=531

They state that the varying combos and antigen formulations makes it difficult to compare and assess the vax safety.

[Rrrrrachel]

I don't think there's a dose response relationship, always. I'm really straining my scientific chops here, but it think things like the amount of antigen, the amount and type of adjuvant, how the surface of the antigen is coated, how the molecules are put together, etc, all interact to determine how sting the immune system responds. It's also my understanding that vaccines aren't like other drugs where a heavier person or adult necessarily needs a larger dose than a smaller person or child.

[slmommy]

Originally Posted by Rrrrrachel 

I don't think there's a dose response relationship, always. I'm really straining my scientific chops here, but it think things like the amount of antigen, the amount and type of adjuvant, how the surface of the antigen is coated, how the molecules are put together, etc, all interact to determine how sting the immune system responds.

This is kinda what I have been assuming re: dtap in pentacel having more antigen than regular daptacel... synergies of many components/manufacturing process... but that was just my guess. I also wonder how far you can get into this question before things get proprietary... 

[haydn'smommy]

Disclaimer: i am a healthcare provider. I mostly vaccinate on schedule for my own kids (minus a few things and rearranging things after 6 mos) but i fully support my nonvaccinating families.

Why do most CDC/department of health publications say that tetanus can be found "anywhere, even house dust" when it is proven that the spores cannot live in oxygen. An aerobic environment like house dust is fully exposed to oxygen, right? A pp gave a great response. It's the endospore that can survive.
Why is the dose for diptheria in the DT or DTaP so much higher for children? What research is there that shows that a (for example)  10 lb baby needs 7 times the dose of diptheria toxin to develop immunity than a 200 lb adult? (This also goes for pertussis, comparing the amount in the DTaP to the Tdap.) Because baby's immune system has never seen these things and we are starting from scratch. In theory, the adult's immune system still has some memory of the antigen and we are only trying to stimulate it so that it retains that memory.
Why is pertussis still bundled in to the 3 part DTaP or Tdap when a full series of Tetanus and Diptheria is 3 doses followed by boosters every 10 years, and pertussis is 4 (or 5, depending on age) doses with a booster needed much more frequently? (Studies coming out say pertussis boosters might be needed every 3-5 years to maintain immunity from the primary series.) I understand why D and T would be bundled since they are on the same schedule, but why pertussis? So much extra D and T is given by combining all 3. I'm sure it has something to do with the manufacturing and synergy between components. Sometimes these things just aren't stable alone. Idk though.
Why were the strains of strep pneumonia that are in Prevnar chosen? Are they the most common strains, the most dangerous, or the ones that were more concerning at the time? Does it make sense to periodically reformulate Prevnar to reflect the current strains out there like is done with the flu vaccine? Prevnar's strains are based upon which ones were most common and most virulent. It was reformulated in 2010 to reflect changes in what we're seeing and now covers 6 additioanl strains.
Are there any books out there that exist to give a factual history of the development of vaccines that are not biased either pro or anti vaccine? No idea. I've never seen one.

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[nukuspot]

Thanks everyone for your responses! I really appreciate them. I think we have definitively answered some questions and gotten good hypothesizes on the others (with the exception of that mythical unbiased vaccine book.)