Vaccines with (Fringe) Benefits

September 14, 2015

Prevnar prevents deadly disease. Like other vaccines, it offers less touted benefits, too; small, but not insignificant.

[[{"type":"media","view_mode":"media_crop","fid":"41278","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_3860760370923","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4334","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 203px; width: 265px; float: right;","title":"©DaynaMore/Shutterstock.com","typeof":"foaf:Image"}}]] From a public health perspective, we can hardly ask for better friends than vaccines. Some even come with side benefits-less important, of course, than the ability to save lives, but helpful to the afflicted, nonetheless. For example, a number of vaccines reduce the risk for ear infections, not life-threatening by any stretch and often self-limited, but certainly disruptive for patient and parent. The pneumococcal vaccine Prevnar has radically reduced the risk of invasive diseases including pneumonias, meningitis, sepsis, and bacteremia. As the vaccine is made with various strains of pneumococcus and many of these are the most common cause of otitis, the fringe benefit of vaccination with Prevnar has been a 20% reduction in ear infections in children receiving the vaccine.

Which of the following other vaccines also reduce the risk of ear infections in children?

A. Hib vaccines
B. Varivax
C. MMR
D. All reduce the risk of ear infections in vaccinated children

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Answer: D. All reduce the risk of ear infections in vaccinated children. (Discussion to follow.)

 

Which of the following vaccines most likely resulted in the biggest drop in otitis risk?

A. Hib vaccines
B. Varivax
C. MMR

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Answer: C. MMR

When I ask this question of pediatric residents, most think that the Hib vaccine would be the best answer, but the correct answer is MMR. They were taught as medical students that the 3 most common pathogens cultured out of infected ears are Pneumococcus, Haemophilus, and Moraxella catarrhalis in that order of frequency. What they usually forget is that the Hib vaccines only protect against the Haemophilus influenza type B strain which caused the invasive Haemophilus diseases:  meningitis, epiglottitis, septic arthritis, periorbital cellulitis, facial cellulitis, and sepsis. In the pre-Hib vaccine era, most strains of Haemophilus cultured from ear infections were the untypeable strains for which the Hib vaccines provide little or no protection. But, the type B strain did cause some middle ear disease so technically, the Hib vaccine does reduce the risk of ear infections.

Chickenpox does not cause the nasal congestion that we all usually associate with an increased risk of eustachian tube blockage that usually precedes an acute otitis media. Nevertheless, up to 5% of children with chickenpox would get otitis media.  Having personally seen lesions on various mucous membranes including sclera, mouth, and vulva, it does not take a leap of imagination to envision a pox in the eustachian tube leading to obstruction.

Up to 40% of children with measles develop other complications such as otitis, pneumonia, and diarrhea.

Friends are great, but friends with benefits are the best.

References:

Marshall G. THE VACCINE HANDBOOK:  A PRACTICAL GUIDE FOR CLINICIANS. 5th ed. 2015.