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Which Vaccines Are the Most Essential?

By 

René F. Najera, DrPH

February 25, 2020

California continues to be a hotbed of anti-vaccine activity after . This week, a group of anti-vaccine protesters met outside the home of the Governor of California to protest the implementation of these laws. As the rally continued, Jennifer Siebel Newsom, partner Governor Newsom, . The Los Angeles Times reports:
In a video taken Monday, Siebel Newsom is seen talking with the protesters about the vaccine laws signed by Gov. Gavin Newsom last year before she asks that they not post the video online. “I think there needs to be more conversation around spreading out vaccines, around only giving children the vaccines that are most essential,” Siebel Newsom says in a portion of the short video posted on the Facebook page of one of the protesters. Before that comment, Siebel Newsom said the head of the California Health and Human Services Agency, Dr. Mark Ghaly, who oversees the public health department tasked with implementing the new laws, is “talking to integrative and functional medicine doctors who understand this.” A spokesman for the governor said the laws signed by Newsom last year are the official position of the administration.
Unfortunately for Ms. Siebel Newsom, the video was posted even after she requested that the group not post the video so social media.

So which vaccines are "most essential" for children in California and the United States?

In the United States, the Advisory Committee on Immunization Practices (ACIP) is a committee tasked with . Serving on that committee is a diverse group of scientists, policymakers and members of the public. They take the best evidence on the safety and efficacy of vaccines, the epidemiology of the diseases the vaccines are meant to prevent and the current levels of immunization in the different populations they're observing. Then they make recommendations on vaccine practices. For the most part, federal, state and local public health authorities and health care providers follow these recommendations and place these vaccines on the . Because of these discussions, there are vaccines that are but are not routinely given to children:
  • Adenovirus: This vaccine is currently not recommended for general use, though there has been discussion about it . It is given to military recruits as there are seasonal epidemics of the disease in recruit barracks, affecting military preparedness.
  • BCG: This vaccine is s to prevent severe forms of non-pneumonic (non-lung-related) tuberculosis.
  • Cholera: The main reason why cholera is transmitted is because of poor sanitation and contaminated water after a natural disaster. In the Western Hemisphere, cholera is now only reported .
  • Dengue: This viral infection is transmitted by mosquitoes in tropical areas. It is endemic (transmission occurring naturally) . In the United States -- with the exception of tropical overseas territories -- the disease is imported by sick travelers, but mosquito control and treatment prevent it from becoming endemic.
  • Ebola: This disease has been occurring in periodic epidemics in the African Continent for decades. (WHO). However, the infection is limited to transmission through contaminated body fluids, placing health care workers and the families of those who are sick at most risk. Cases in the United States have been from travelers returning with the disease after time in affected countries.
  • Japanese Encephalitis: This is a very rare disease that , and most people who are infected with the virus do not show symptoms. It is transmitted by mosquitoes, so the risk of infection when traveling to Asia depends on the location and length of travel as well as precautions taken to avoid mosquito bites.
  • Plague: This bacterial infection is primarily transmitted by fleas found on certain rodents. , even recently, most cases are limited and transmission from person-to-person in minimal. .
  • Rabies: In the United States, rabies vaccine is only recommended for . Once symptoms of rabies set in, the disease is 99.999% deadly. However, if the vaccine is given shortly after exposure and before symptoms appear, the disease is 99.999% preventable. . Worldwide, .
  • Smallpox: The virus that causes smallpox was the first virus to be eradicated from the planet through the use of the smallpox vaccine. That vaccine was the first one developed by Dr. Edward Jenner back in the late 1700s. Because two stockpiles of the vaccine remain (one in the United States and one in Russia), of the virus. As a result, , but it is not recommended for the general public.
  • Typhoid Fever: This is another bacterial infection that results from . nowadays with water sanitation and closed sewers being predominant. Food handling guidelines and local health department inspections have also kept it in check. There are a variety of antibiotics against it as well.
  • Yellow Fever: Yellow Fever is another mosquito-borne infection that is found in the tropics. .
As you can see, not all licensed vaccines are on the schedule to be given to children in the United States. This is because there are effective control measures that keep these diseases out of the country or -- if they are introduced -- they are contained quickly through different measures. There used to be a time when vaccines like the smallpox vaccine, typhoid fever vaccine or the BCG vaccine were used in the United States. But and a decrease in the probability of outbreaks from them have removed them from the schedule. The discussion which vaccines are necessary and when to give them is already happening at least twice a year by ACIP. State and local health officials also discuss the recommendations as they are the final arbiters on which vaccines to give. This is something that is widely denied by anti-vaccine groups and activists, but there is ample evidence like the transcripts of ACIP meetings and the Vaccine Information Statements from CDC that show the evidence for the need of the current vaccines being administered to children and adults in the United States.

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